【摘要】 目的 分析超声心动图指导下输液管理在老年患者骨科下肢手术中的应用效果。方法 选取2018年1月—2024年12月于包头市第三医院行骨科下肢手术的60例70岁及以上老年患者，采用随机数字表法将患者分为常规输液组（S组）和超声心动图指导下的输液组（N组），每组各30例。患者均采用椎管内腰硬联合麻醉方式进行手术。N组通过测量下腔静脉呼吸变异度（IVC-RVI）精准指导输液，S组则按照常规补液方案进行输液。比较两组患者入手术室（T₀）、麻醉后（麻醉给药后10 min时，T₁）、手术开始（T₂）、手术中（手术开始后40 min,T₃）及术毕（T₄）的心率（HR）、平均动脉压（MAP）、收缩压（SBP）、舒张压（DBP）和经皮动脉血氧饱和度（SpO₂），术中出血量、尿量、总输液量、晶体液和胶体液的用量及手术时间，以及术后住院时间、肺部并发症、伤口感染、术后恶心呕吐及24 h内心血管事件的发生情况。结果 两组患者T₀时的HR、MAP、SBP和DBP水平比较，差异无统计学意义（P>0.05）;N组T₁、T₂、T₃、T₄时的HR、MAP、SBP和DBP水平优于S组，差异有统计学意义（P<0.05）。N组患者术中的液体输入总量、晶体液用量、胶体液输入量和尿量均少于S组，差异有统计学意义（P<0.05）；两组患者的术中出血量比较，差异无统计学意义（P>0.05）。N组患者的住院时间短于S组，术后并发症总发生率低于S组，差异有统计学意义（P<0.05）。结论 超声心动图能够精确评估老年患者血容量的变化，从而指导麻醉医生术中对老年患者进行输液管理，并有助于降低老年患者术后并发症发生率，值得临床应用。更多还原

【Abstract】 Objective To analyze the application effect of infusion management under the guidance of echocardiography in elderly patients undergoing orthopedic lower limb surgery.Methods A total of 60 elderly patients aged 70 and above who underwent lower extremity orthopedic surgery in Baotou Third Hospital from January 2018 to December 2024 were selected and divided into the conventional infusion group（group S） and the ultrasound echocardiography-guided infusion group（group N）according to the random number table method,with 30 patients in each group.All surgeries were performed using intraspinal combined spinal-epidural anesthesia.Group N precisely guided the infusion by measuring the inferior vena cava respiratory variation index（IVC-RVI）,while group S followed the conventional fluid replacement plan.The heart rate（HR）,mean arterial pressure（MAP）,systolic blood pressure（SBP）,diastolic blood pressure（DBP） and transcutaneous arterial oxygen saturation（SpO₂） were compared between the two groups at the time of entering the operating room（T₀）,after anesthesia（10 minutes after drug administration,T₁）,at the beginning of the surgery（T₂）,during the surgery（40 minutes after the start of the surgery,T₃）,and at the end of the surgery（T4）.The intraoperative blood loss,urine output,total infustion volume,crystalloid and colloid fluid usage and operation time,as well as the postoperative hospital stay,pulmonary complications,wound infection,postoperative nausea and vomiting,and the occurrence of cardiovascular events within 24 hours were compared between the two groups.Results There were no statistically significant differences in the level, of HR,MAP,SBP and DBP between the two groups at T₀（P> 0.05）.The levels of HR,MAP SBP and DBP in group N at T₁,T₂,T₃ and T₄ were better than those in group S,with statistically significant differences（P <0.05）.The total infusion input during the operation,the amount of crystalloid fluid used,the amount of colloid fluid input and the urine output in group N were all less than those in group S,with statistically significant differences（P <0.05）.There was no statistically significant difference in the intraoperative blood loss between the two groups（P> 0.05）.The hospital stay of patients in group N was shorter than that of group S,and the total incidence of postoperative complications in group N was lower than that of group S,with statistically significant differences（P <0.05）.Conclusions Echocardiography can accurately assess changes in blood volume in elderly patients,so as to guide anesthesiologists to administer infusion management during surgery,and help reduce the incidence of postoperative complications in elderly patients,which is worthy of clinical application.更多还原