目标导向液体疗法对老年手术病人围术期微循环灌注的影响

doi:10.16139/j.1007-9610.2025.01.17

摘要/Abstract

摘要：

随着老年手术病人增多，麻醉医师面临更大的挑战。老年病人在围术期的微循环灌注与健康预后密切相关，本文探讨新兴的目标导向液体治疗对老年手术病人微循环灌注的影响，旨在为临床实践提供新思路。

Abstract:

With the increasing number of elderly surgical patients, anesthesiologists are confronted with greater challenges. Given the close association between perioperative microcirculatory perfusion and health outcomes in geriatric populations, this article explored the impact of emerging goal-directed fluid therapy (GDFT) on microcirculatory perfusion in elderly surgical patients, aiming to provide new insights for optimizing clinical practice.

Key words: Goal-directed fluid therapy (GDFT), Elder population, Microcirculation perfusion, Perioperative management

中图分类号:

邱艳丽, 朱倩林, 罗艳. 目标导向液体疗法对老年手术病人围术期微循环灌注的影响[J]. 外科理论与实践, 2025, 30(01): 88-92.

QIU Yanli, ZHU Qianlin, LUO Yan. Effect of goal-directed fluid therapy on perioperative microcirculatory perfusion in elderly patients undergoing surgery[J]. Journal of Surgery Concepts & Practice, 2025, 30(01): 88-92.

图/表 1

参考文献 33

[1]	BRUNO R R, MASYUK M, MUESSIG J M, et al. Sublingual microcirculation detects impaired perfusion in dehydrated older patients[J]. Clin Hemorheol Microcirc, 2020, 75(4):475-487. doi: 10.3233/CH-200859 pmid: 32417766
[2]	王天龙, 张宏. 围术期老年医学应成为老年麻醉学的努力方向[J]. 临床麻醉学杂志, 2018, 34(7):629-630.
	WANG T L, ZHANG H. Perioperative geriatrics should become the direction of geriatric anesthesiology[J]. J Clin Anesthesiol, 2018, 34(7):629-630.
[3]	李建中, 李明德, 叶德珍. 健康老年人与常见老年病患者的甲襞微循环观察[J]. 微循环技术杂志, 1993(3):153-154,129.
	LI J Z, LI M D, YE D Z. Observation of nail fold microcirculation in healthy elderly and common geriatric patients[J]. J Microcirc Technol, 1993(3):153-154,129.
[4]	霍瑞婷, 关小宏. 糖尿病足患者糖尿病肾病与糖尿病视网膜病变的微循环障碍特点分析[J]. 医学综述, 2016, 22(13):2593-2596.
	HUO R T, GUAN X H. Analysis of microcirculatory disorders in diabetic nephropathy and diabetic retinopathy in patients with diabetic foot[J]. Medical Review, 2016, 22(13):2593-2596.
[5]	REN W, DUAN Y, JAN Y K, et al. Effect of exercise vo-lume on plantar microcirculation and tissue hardness in people with type 2 diabetes[J]. Front Bioeng Biotechnol, 2021,9:732628.
[6]	MITROPOULOS A, GUMBER A, CRANK H, et al. The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients[J]. Arthritis Res Ther, 2018, 20(1):112. doi: 10.1186/s13075-018-1605-0 pmid: 29871697
[7]	吴国豪. 微循环功能与脏器灌注——预后的重要评价指标[J]. 中国实用外科杂志, 2007, 27(8):595-596.
	WU G H. Microcirculatory function and organ perfusion: an important evaluation index of prognosis[J]. Chin J Pract Surg, 2007, 27(8):595-596.
[8]	GUTTERMAN D D, CHABOWSKI D S, KADLEC A O, et al. The human microcirculation: regulation of flow and beyond[J]. Circ Res, 2016, 118(1):157-172. doi: 10.1161/CIRCRESAHA.115.305364 pmid: 26837746
[9]	VAN DE HOEF T P, ECHAVARRIA-PINTO M, MEUWISSEN M, et al. Contribution of age-related microvascular dysfunction to abnormal coronary: hemodyna-mics in patients with ischemic heart disease[J]. JACC Cardiovasc Interv, 2020, 13(1):20-29.
[10]	LAI M M Y, SHARMAN M J, AMES D J, et al. Relationship of established cardiovascular risk factors and peri-pheral biomarkers on cognitive function in adults at risk of cognitive deterioration[J]. J Alzheimers Dis, 2020, 74(1):163-171.
[11]	ZHOU Y, LI P, GOODWIN A J, et al. Exosomes from endothelial progenitor cells improve the outcome of a murine model of sepsis[J]. Mol Ther, 2018, 26(5):1375-1384. doi: S1525-0016(18)30073-X pmid: 29599080
[12]	杨超杰, 高晓增, 谭志斌, 等. 以SVV为指导的液体治疗对复合麻醉下老年腹腔镜结肠癌根治术患者肠道屏障的影响[J]. 山东医药, 2018, 58(18):12-16.
	YANG C J, GAO X Z, TAN Z B, et al. Effect of SVV-guided fluid therapy on intestinal barrier in elderly patients undergoing laparoscopic radical colectomy under combined anesthesia[J]. Shandong Med, 2018, 58(18):12-16.
[13]	DUBIN A, HENRIQUEZ E, HERNÁNDEZ G. Monitoring peripheral perfusion and microcirculation[J]. Curr Opin Crit Care, 2018, 24(3):173-180. doi: 10.1097/MCC.0000000000000495 pmid: 29553951
[14]	阎乃璐, 陆菡, 于布为. 围术期微循环的相关研究进展[J]. 上海交通大学学报(医学版), 2021, 41(1):108-111. doi: 10.3969/j.issn.1674-8115.2021.01.020
	YAN N L, LU H, YU B W. Research progress in peri-operative microcirculation[J]. J Shanghai Jiao Tong Univ:Med Sci, 2021, 41(1):108-111.
[15]	中华医学会麻醉学分会老年人麻醉学组. 中国老年患者围术期麻醉管理指导意见[J]. 国际麻醉学与复苏杂志, 2014, 35(10):870-881,901.
	Geriatric Anaesthesia Group of the Anaesthesiology Branch of the Chinese Medical Association. Guidelines on perioperative anaesthesia management for elderly patients in China[J]. Int J Anesthesiol Resusc, 2014, 35(10):870-881,901.
[16]	RUSSO A, AUTELITANO M, BISANTI L. Re: 30-day mortality and major complications after radical prostatectomy: influence of age and comorbidity[J]. J Natl Cancer Inst, 2006, 98(6):421;author reply 421-422. pmid: 16537836
[17]	BRUEGGER D, JACOB M, REHM M, et al. Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts[J]. Am J Physiol Heart Circ Physiol, 2005, 289(5):H1993-H1999.
[18]	马红梅, 郭莹莹, 吴智宏, 等. FloTrac/Vigileo系统监测调控CO₂气腹压改善腹腔镜手术患者血流动力学的效果观察[J]. 中国医学装备, 2018, 15(8):67-71.
	MA H M, GUO Y Y, WU Z H, et al. Effect of FloTrac/Vigileo system monitoring and regulation of CO₂ pneumoperitoneum pressure on improving hemodynamics in patients undergoing laparoscopic surgery[J]. China Med Equip, 2018, 15(8):67-71.
[19]	DENG Y, ZHU Q, YU B, et al. The effects of hypervo-lemic infusion on microcirculation perfusion of patients during laparoscopic colorectal surgery[J]. Medicine (Baltimore), 2017, 96(45):e8612.
[20]	MAKARYUS R, MILLER T E, GAN T J. Current concepts of fluid management in enhanced recovery pathways[J]. Br J Anaesth, 2018, 120(2):376-383. doi: S0007-0912(17)53976-8 pmid: 29406186
[21]	张玉龙, 封小美, 薛庆生, 等. 麻醉期间影响微循环正常活动的有关因素[J]. 上海医学, 2010, 33(10):966-969.
	ZHANG Y L, FENG X M, XUE Q S, et al. Factors involved in influencing the normal activity of the microcirculation during anaesthesia[J]. Shanghai Med J, 2010, 33(10):966-969.
[22]	BENNETT V A, VIDOURIS A, CECCONI M. Effects of fluids on the macro- and microcirculations[J]. Crit Care, 2018, 22(1):74.
[23]	PRANSKUNAS A, KOOPMANS M, KOETSIER P M, et al. Microcirculatory blood flow as a tool to select ICU patients eligible for fluid therapy[J]. Intensive Care Med, 2013, 39(4):612-619. doi: 10.1007/s00134-012-2793-8 pmid: 23263029
[24]	LOPES M R, OLIVEIRA M A, PEREIRA V O, et al. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot rando-mized controlled trial[J]. Crit Care, 2007, 11(5):R100.
[25]	GOTTIN L, MARTINI A, MENESTRINA N, et al. Peri-operative fluid administration in pancreatic surgery: a comparison of three regimens[J]. J Gastrointest Surg, 2020, 24(3):569-577.
[26]	BENES J, CERNY V. Fluid therapy and endothelial glycocalyx layer. On the track of the water-phobic Bigfoot[J]. Minerva Anestesiol, 2018, 84(9):1007-1009. doi: 10.23736/S0375-9393.18.12811-2 pmid: 29624031
[27]	刘洋, 田丹丹, 张超凡, 等. 目标导向液体治疗对妇科腹腔镜手术术中血流动力学及脑氧饱和度的影响[J]. 临床麻醉学杂志, 2020, 36(4):349-353.
	LIU Y, TIAN D D, ZHANG C F, et al. Effect of goal-directed fluid therapy on intraoperative hemodynamics and cerebral oxygen saturation in gynecological laparoscopic surgery[J]. J Clin Anesthesiol, 2020, 36(4):349-353.
[28]	SUN Y, CHAI F, PAN C, et al. Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery-a systematic review and meta-analysis of randomized controlled trials[J]. Crit Care, 2017, 21(1):141.
[29]	王文珊. 目标导向液体治疗对胃肠道肿瘤患者肠道运动功能的影响[D]. 华北理工大学, 2016.
	WANG W S. Effect of goal-directed fluid therapy on intestinal motor function in elderly patients with gastrointestinal tumors[D]. North China Univ Sci Technol, 2016.
[30]	FORGET P, LOIS F, DE KOCK M. Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management[J]. Anesth Analg, 2010, 111(4):910-914. doi: 10.1213/ANE.0b013e3181eb624f pmid: 20705785
[31]	SELF W H, EVANS C S, JENKINS C A, et al. Clinical effects of balanced crystalloids vs saline in adults with diabetic ketoacidosis: a subgroup analysis of cluster rando-mized clinical trials[J]. JAMA Netw Open, 2020, 3(11):e2024596.
[32]	GUZMÁN-CALDERÓN E, DIAZ-AROCUTIPA C, MONGE E. Lactate ringer's versus normal saline in the management of acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials[J]. Dig Dis Sci, 2022, 67(8):4131-4139.
[33]	WANG G, ZHANG H, LIU D, et al. Resuscitation fluids as drugs: targeting the endothelial glycocalyx[J]. Chin Med J (Engl), 2022, 135(2):137-144.