{"title":"评估和控制使用估计连续心输出量技术对肥胖患者择期疝成形术的容血状态校正","authors":"N. V. Davydov","doi":"10.24884/2072-6716-2022-23-3-24-32","DOIUrl":null,"url":null,"abstract":"The objective. To substantiate the use of the Estimated Continuous Cardiac Output technology for the assessment and correction of the volemic status in obese patients during routine hernia repair of the anterior abdominal wall under spinal anesthesia. Subjects and methods. The study included 40 patients who underwent hernia repair of the anterior abdominal wall under spinal anesthesia. Inclusion criteria: body mass index of more than 30–40 kg/m2, physical status according to ASA II or III, no history of indications of diabetes mellitus, myocardial infarction, stroke, malignant neoplasm. Exclusion criteria: refusal of the patient, contraindications to spinal anesthesia. The patients were randomly divided into 2 groups of 20 people. Patients of both groups were comparable in age, gender, and physical status. Group 1 patients underwent preoperative evaluation, as well as monitoring of the effectiveness of correction of volemic status using EsCCO technology. Intraoperative infusion therapy was prescribed to patients of group 2 based on the doctor’s experience, blood pressure, heart rate and formulas for calculating the infusion load. Statistical analysis of the data obtained was performed using MS Excel, Statistica 10. To test the hypothesis of the normality of the distribution of a random variable, the Shapiro-Wilk test was used. Under conditions of normal distribution of quantitative indicators, descriptive statistics were used for statistical data analysis: mean value (M); standard deviation (SD); 95% confidence interval of standard deviation (C1). The Student’s t-test was used to analyze the differences between quantitative characteristics. The differences were considered significant at p<0.05. Results. The greatest decrease in systolic blood pressure by 4 minutes (from 122.8 to 117.5 mm Hg, by 4.3%) was revealed among group 1A patients, by 2 minutes (from 120.6 to 115.4 mm Hg, by 4.3%) among group 2 patients by 4 minutes (from 123.4 to 107.2 mm Hg, by 13.1%) from spinal anesthesia. The most pronounced change in heart rate relative to baseline data among group 1A and group 1B patients was noted at 2 minutes after intrathecal administration of bupivacaine (from 72.4 to 76.2, by 5% and from 74.6 to 78.4, by 4.8%, respectively) with a gradual return to parameters that are close to the baseline, and among patients in group 2, a sharp jump in heart rate from 73.8 to 83.3 (by 11.4%) was noted at 2 minutes. Heart rate continued to increase and by 6 minutes reached an average of 86.0, which is 14% higher than the original value. In all three groups of the study, the greatest deviation from the baseline was found at 6 minutes after the administration of bupivacaine with a further gradual return to slightly larger parameters than the base[1]line. Significant changes in SI were detected at 6 minutes from the execution of the neuroaxial block among all patients of this study. For group 1A, they ranged from 3.89 to 5.25 l/min/m2 (by 27.6%), for group 1B patients from 3.88 to 5.1 l/min/m2 (by 23.9%) and for group 2 from 3.84 to 5.45 l/min/m2 (by 29.5%). Conclusion. The Estimated Continuous Cardiac Output technology can be effectively used to assess and correct the volemic status in obese patients when performing elective hernia repair of the anterior abdominal wall under spinal anesthesia.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluation and control of correction of volemic status using estimated continuous cardiac output technology for elective hernioplasty in obese patients\",\"authors\":\"N. V. Davydov\",\"doi\":\"10.24884/2072-6716-2022-23-3-24-32\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"The objective. To substantiate the use of the Estimated Continuous Cardiac Output technology for the assessment and correction of the volemic status in obese patients during routine hernia repair of the anterior abdominal wall under spinal anesthesia. Subjects and methods. The study included 40 patients who underwent hernia repair of the anterior abdominal wall under spinal anesthesia. Inclusion criteria: body mass index of more than 30–40 kg/m2, physical status according to ASA II or III, no history of indications of diabetes mellitus, myocardial infarction, stroke, malignant neoplasm. Exclusion criteria: refusal of the patient, contraindications to spinal anesthesia. The patients were randomly divided into 2 groups of 20 people. Patients of both groups were comparable in age, gender, and physical status. Group 1 patients underwent preoperative evaluation, as well as monitoring of the effectiveness of correction of volemic status using EsCCO technology. Intraoperative infusion therapy was prescribed to patients of group 2 based on the doctor’s experience, blood pressure, heart rate and formulas for calculating the infusion load. Statistical analysis of the data obtained was performed using MS Excel, Statistica 10. To test the hypothesis of the normality of the distribution of a random variable, the Shapiro-Wilk test was used. Under conditions of normal distribution of quantitative indicators, descriptive statistics were used for statistical data analysis: mean value (M); standard deviation (SD); 95% confidence interval of standard deviation (C1). The Student’s t-test was used to analyze the differences between quantitative characteristics. The differences were considered significant at p<0.05. Results. The greatest decrease in systolic blood pressure by 4 minutes (from 122.8 to 117.5 mm Hg, by 4.3%) was revealed among group 1A patients, by 2 minutes (from 120.6 to 115.4 mm Hg, by 4.3%) among group 2 patients by 4 minutes (from 123.4 to 107.2 mm Hg, by 13.1%) from spinal anesthesia. The most pronounced change in heart rate relative to baseline data among group 1A and group 1B patients was noted at 2 minutes after intrathecal administration of bupivacaine (from 72.4 to 76.2, by 5% and from 74.6 to 78.4, by 4.8%, respectively) with a gradual return to parameters that are close to the baseline, and among patients in group 2, a sharp jump in heart rate from 73.8 to 83.3 (by 11.4%) was noted at 2 minutes. Heart rate continued to increase and by 6 minutes reached an average of 86.0, which is 14% higher than the original value. In all three groups of the study, the greatest deviation from the baseline was found at 6 minutes after the administration of bupivacaine with a further gradual return to slightly larger parameters than the base[1]line. Significant changes in SI were detected at 6 minutes from the execution of the neuroaxial block among all patients of this study. For group 1A, they ranged from 3.89 to 5.25 l/min/m2 (by 27.6%), for group 1B patients from 3.88 to 5.1 l/min/m2 (by 23.9%) and for group 2 from 3.84 to 5.45 l/min/m2 (by 29.5%). Conclusion. The Estimated Continuous Cardiac Output technology can be effectively used to assess and correct the volemic status in obese patients when performing elective hernia repair of the anterior abdominal wall under spinal anesthesia.\",\"PeriodicalId\":37398,\"journal\":{\"name\":\"Sklifosovsky Journal Emergency Medical Care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-09-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Sklifosovsky Journal Emergency Medical Care\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.24884/2072-6716-2022-23-3-24-32\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Sklifosovsky Journal Emergency Medical Care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.24884/2072-6716-2022-23-3-24-32","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
我们的目标。目的:验证脊髓麻醉下肥胖患者常规前腹壁疝修补术中使用预估连续心输出量技术评估和校正容血状态的可行性。研究对象和方法。该研究包括40例在脊髓麻醉下行前腹壁疝修补术的患者。纳入标准:体重指数大于30-40 kg/m2,身体状况按ASA II或III级,无糖尿病、心肌梗死、脑卒中、恶性肿瘤等适应症史。排除标准:患者拒绝,脊髓麻醉禁忌症。患者被随机分为两组,每组20人。两组患者在年龄、性别和身体状况上具有可比性。第一组患者接受术前评估,并监测使用EsCCO技术校正血容量状态的有效性。2组患者根据医生经验、血压、心率及输液负荷计算公式进行术中输液治疗。使用MS Excel, Statistica 10对所得数据进行统计分析。为了检验随机变量分布的正态性假设,使用夏皮罗-威尔克检验。定量指标在正态分布条件下,采用描述性统计方法对统计数据进行分析:均值(M);标准差(SD);95%置信区间标准差(C1)。使用学生t检验来分析数量特征之间的差异。p<0.05认为差异有统计学意义。结果。1A组患者收缩压下降幅度最大,为4分钟(从122.8到117.5 mm Hg,下降4.3%),2组患者收缩压下降幅度最大,为4分钟(从120.6到115.4 mm Hg,下降4.3%),为4分钟(从123.4到107.2 mm Hg,下降13.1%)。与基线数据相比,1A组和1B组患者在鞘内给予布比卡因后2分钟的心率变化最明显(分别从72.4到76.2,分别增加5%和从74.6到78.4,分别增加4.8%),并逐渐恢复到接近基线的参数,而在2组患者中,心率在2分钟内从73.8急剧上升到83.3(增加11.4%)。心率继续增加,6分钟达到平均86.0,比原始值高14%。在所有三组研究中,与基线的最大偏差出现在布比卡因给药后6分钟,随后逐渐恢复到比基线略大的参数[1]。在本研究的所有患者中,在执行神经轴阻滞后6分钟检测到SI的显著变化。对于1A组,其范围为3.89至5.25 l/min/m2(27.6%),对于1B组患者,其范围为3.88至5.1 l/min/m2(23.9%),对于2组患者,其范围为3.84至5.45 l/min/m2(29.5%)。结论。估计连续心输出量技术可以有效地评估和纠正肥胖患者在脊髓麻醉下行前腹壁疝修补术时的容血状态。
Evaluation and control of correction of volemic status using estimated continuous cardiac output technology for elective hernioplasty in obese patients
The objective. To substantiate the use of the Estimated Continuous Cardiac Output technology for the assessment and correction of the volemic status in obese patients during routine hernia repair of the anterior abdominal wall under spinal anesthesia. Subjects and methods. The study included 40 patients who underwent hernia repair of the anterior abdominal wall under spinal anesthesia. Inclusion criteria: body mass index of more than 30–40 kg/m2, physical status according to ASA II or III, no history of indications of diabetes mellitus, myocardial infarction, stroke, malignant neoplasm. Exclusion criteria: refusal of the patient, contraindications to spinal anesthesia. The patients were randomly divided into 2 groups of 20 people. Patients of both groups were comparable in age, gender, and physical status. Group 1 patients underwent preoperative evaluation, as well as monitoring of the effectiveness of correction of volemic status using EsCCO technology. Intraoperative infusion therapy was prescribed to patients of group 2 based on the doctor’s experience, blood pressure, heart rate and formulas for calculating the infusion load. Statistical analysis of the data obtained was performed using MS Excel, Statistica 10. To test the hypothesis of the normality of the distribution of a random variable, the Shapiro-Wilk test was used. Under conditions of normal distribution of quantitative indicators, descriptive statistics were used for statistical data analysis: mean value (M); standard deviation (SD); 95% confidence interval of standard deviation (C1). The Student’s t-test was used to analyze the differences between quantitative characteristics. The differences were considered significant at p<0.05. Results. The greatest decrease in systolic blood pressure by 4 minutes (from 122.8 to 117.5 mm Hg, by 4.3%) was revealed among group 1A patients, by 2 minutes (from 120.6 to 115.4 mm Hg, by 4.3%) among group 2 patients by 4 minutes (from 123.4 to 107.2 mm Hg, by 13.1%) from spinal anesthesia. The most pronounced change in heart rate relative to baseline data among group 1A and group 1B patients was noted at 2 minutes after intrathecal administration of bupivacaine (from 72.4 to 76.2, by 5% and from 74.6 to 78.4, by 4.8%, respectively) with a gradual return to parameters that are close to the baseline, and among patients in group 2, a sharp jump in heart rate from 73.8 to 83.3 (by 11.4%) was noted at 2 minutes. Heart rate continued to increase and by 6 minutes reached an average of 86.0, which is 14% higher than the original value. In all three groups of the study, the greatest deviation from the baseline was found at 6 minutes after the administration of bupivacaine with a further gradual return to slightly larger parameters than the base[1]line. Significant changes in SI were detected at 6 minutes from the execution of the neuroaxial block among all patients of this study. For group 1A, they ranged from 3.89 to 5.25 l/min/m2 (by 27.6%), for group 1B patients from 3.88 to 5.1 l/min/m2 (by 23.9%) and for group 2 from 3.84 to 5.45 l/min/m2 (by 29.5%). Conclusion. The Estimated Continuous Cardiac Output technology can be effectively used to assess and correct the volemic status in obese patients when performing elective hernia repair of the anterior abdominal wall under spinal anesthesia.
期刊介绍:
The Journal "Neotlozhnaia meditsinskaia pomoshch" (parallel titles: Zhurnal im. N.V. Sklifosovskogo "Neotlozhnai︠a︡ medit︠s︡inskai︠a︡ pomoshch", "Sklifosovsky Journal of Emergency Medical Care") seeks to publish original research articles, literature reviews, case reports, brief reports on clinical practice, and other suitable material submitted by professionals involved in the diagnosis and treatment of acute medical and surgical conditions.