目标导向液体治疗联合超声动态监测血管外肺水在老年全髋关节置换病人液体管理中的应用

doi:10.3969/j.issn.1003-9198.2023.12.006

Abstract

Abstract: Objective To explore the value of goal-directed fluid therapy(GDFT) combined with ultrasound-guided dynamic monitoring of extravascular lung water (EVLW) in the elderly patients receiving total hip arthroplasty (THA). Methods A total of 97 elderly patients who underwent THA surgery at Jianhu County People's Hospital were enrolled and randomly divided into the observation group (n=48) and the control group (n=49). The observation group received GDFT, while the control group received conventional perioperative fluid management. The levels of mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI), blood lactic acid, oxygen index (OI), peak airway pressure (PIP), and the incidence of pulmonary-related complications were recorded and compared between the two groups at different time points.Meanwhile, score of B line was observed by lung ultrasomd and EVLW was monitored. Results The fluid replenishment amount in the observation group was significantly lower than that in the control group (P<0.01). The level of MAP and B line score in the observation group 30 min after tracheal intubation and after the operation were significantly lower than those in the control group (P<0.05).The level of CI 15 min,30 min after tracheal intubation and the level of SVI 30 min after tracheal intubation in the observation group were significantly higher than those in the control group (P<0.05). The levels of blood lactic acid and PIP 15 min, 30 min after tracheal intubation and after the operation in the observation group were significantly lower and the level of OI was higher than those in the control group (P<0.05). There was significant difference in the incidence rate of pulmonary complications between the observation group and the control group (4.2% vs 16.3%,P<0.05). Conclusions For elderly patients undergoing THA, GDFT combined with ultrasound-guided dynamic monitoring of EVLW can help to supplement the appropriate total amount of fluid and maintain stable hemodynamics, reduce the incidence of lung complications, protect the lung function.

Key words: lung ultrasound, total hip arthroplasty, goal-directed fluid therapy, volume management, extravascular lung water

CLC Number:

R 683.3

SUN Xiao-yan, ZHANG Zhen-en, LI Tong, XU Jun. Clinical application of goal-directed fluid therapy combined with ultrasound-guided dynamic monitoring of extravascular pulmonary water in elderly patients receiving total hip arthroplasty[J]. Practical Geriatrics, 2023, 37(12): 1210-1214.

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Clinical application of goal-directed fluid therapy combined with ultrasound-guided dynamic monitoring of extravascular pulmonary water in elderly patients receiving total hip arthroplasty

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