目标导向液体治疗在儿童颅咽管瘤切除术中的应用研究  

Effect of goal-directed fluid therapy on the management and outcome of craniopharyngioma resection in children

作　　者：乔岚歆 张建敏[1] 李立晶[1] 蔡黎明 王帆 Qiao Lanxin;Zhang Jianmin;Li Lijing;Cai Liming;Wang Fan(Department of Anesthesiology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科,北京100045

出　　处：《临床小儿外科杂志》2023年第2期144-148,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨由脉压变异度指导的目标导向液体治疗在儿童颅咽管瘤切除术中的应用以及对患儿转归的影响。方法以2020年3月至2021年10月首都医科大学附属北京儿童医院择期行颅咽管瘤切除术的40例患儿为研究对象,年龄1~5岁,性别不限,美国麻醉医师协会分级(American Society of Anesthesiologists,ASA)Ⅱ~Ⅲ级。采用前瞻性研究设计,按随机数字表法分为目标导向液体治疗(goal-directed fluid therapy,GDFT)组(G组)和传统液体治疗组(C组)。G组术中采用脉压变异度(pulse pressure variability,PPV)指导的GDFT方案输注液体,C组术中采用传统"4—2—1"补液原则进行液体输注。记录手术开始时(T1)、切开硬脑膜前(T2)、手术结束时(T3)的平均动脉压(mean arterial pressure,MAP),心率(heart rate,HR),术中各种类型液体出入量,抗利尿药物、血管活性药使用率,电解质情况和术后住院时间。结果C组患儿T3时间点HR值显著高于T1时间点[(96.1±22.4)次/分比(82.4±8.4)次/分],且T3时间点C组HR值显著高于G组[(96.1±22.4)次/分比(83.2±12.8)次/分](P<0.05);其余时间点两组HR值及MAP值差异无统计学意义(P>0.05)。在液体出入量方面,G组输注晶体液量、尿量显著多于C组[(826.0±341.8)mL比(610.0±266.7)mL;(495.0±216.2)mL比(284.0±202.1)mL](P<0.05),其余指标差异无统计学意义(P>0.05)。G组电解质紊乱的发生率低于C组[血K^(+)异常0%(0/20)比25%(5/20)](P<0.05),术后住院时间明显少于C组[(8.6±1.8)d比(10.6±3.2)d](P<0.05)。两组术中抗利尿药物[5%(1/20)比5%(1/20)]与血管活性药物使用率[0%(0/20)比5%(1/20)]以及手术时间[(324.8±47.7)min比(328.0±68.0)min]差异无统计学意义(P>0.05)。结论脉压变异度引导GDFT应用于择期颅咽管瘤切除术患儿,有助于维持其术中血流动力学稳定,降低术后电解质紊乱的发生率,缩短术后住院时间。Objective To explore the effects of goal-directed fluid therapy(GDFT)guided by pulse pressure variability(PPV)on the management of craniopharyngioma resection,and the impact of outcome in children.Methods A total of 40 children aged 1-5 years with American Society of Anesthesiologists physical statusⅡ-Ⅲunderwent elective craniopharyngioma resection.They were randomized into two groups of GDFT(group G)and conventional fluid treatment(group C).Intraoperative PPV-guided fluid infusion was offered in group G and traditional"4-2-1"fluid infusion in group C.Values of mean arterial pressure(MAP)and heart rate(HR)at the beginning of operation(T1),before dural incision(T2),at the end of operation(T3),intraoperative fluid status,utilization rate of antidiuretics and vasoactive agents,electrolyte status and postoperative hospital stay were recorded.Results At T3,HR was significantly higher in group C than that in group G[(96.1±22.4)bpm vs.(82.4±8.4)bpm](P<0.05)and at T1[(96.1±22.4)bpm vs.(82.4±8.4)bpm].No significant inter-group difference existed in HR or MAP at other timepoints(P>0.05).In terms of fluid input/output,crystal fluid volume[(826.0±341.8)mL vs.(610.0±266.7)mL]and urine volume[(495.0±216.2)mL vs.(284.0±202.1)mL]were significantly higher in group G than those in group C(P<0.05)and the rest had no statistical significance.The incidence of electrolyte disturbance[0%(0/20)vs.25%(5/20)](K^(+))and postoperative hospitalization time[(8.6±1.8)d vs.(10.6±3.2)d]were significantly lower in group G than those in group C(P<0.05).No significant inter-group difference existed in intraoperative utilization rate of antidiuretics[5%(1/20)vs.5%(1/20)]and vasoactive agents[0%(0/20)vs.5%(1/20)]or operative duration[(324.8±47.7)min vs.(328.0±68.0)min](P>0.05).Conclusion In children undergoing elective craniopharyngioma resection,PPV-guided GDFT may maintain the stability of intraoperative hemodynamics,reduce the incidence of postoperative electrolyte disorders and shorten postoperative hospitalization stay.

关 键 词：颅咽管瘤 神经外科手术 补液疗法 治疗结果 儿童 

分 类 号：R739.41[医药卫生—肿瘤]