围手术期液体疗法在恶性梗阻性黄疸中的减黄作用  

Efficacy of perioperative supplement of sufficient fluid in treating malignant obstructive jaundice

作　　者：张利辉[1] 崔忠[1] 孙建斌[1] 王振全[1] 赵清涛[1] 

机构地区：[1]中国人民解放军白求恩国际和平医院肝胆外科,石家庄050082

出　　处：《中国肿瘤临床与康复》2006年第4期379-382,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨恶性梗阻性黄疸患者围手术期采用液体疗法促进减黄的疗效。方法收集我院1997至2003年手术治疗的血清胆红素〉171μmol／L（10mg）的恶性梗阻性黄疸患者198例，在解除胆道梗阻后通过增加补液量与否分组对比，观察液体治疗在短期内促进减黄的作用。结果液体组术后1周内91．4％的病例总胆红素降至200μmol／L以下，液体组较对照组术后血清胆红素下降50％的时间有显著的缩短。只要充分胆道引流，短期内液体组减黄速度与原发病、手术种类无关。液体组手术前后所测各项肝功能指标的相关分析显示：TB与ALP显著相关，而TB和ALP与其他各值之间无显著相关关系。液体组术后1周内日尿量2500～3000ml与日尿量〉3000ml的降黄速度差异无显著性。结论恶性梗阻性黄疸患者在围手术期增加补液量，通过利尿促进减黄，方法简便、有效，并能减少术后并发症的发生。Objective To explore the effects of supplement of sufficient fluid on patients with malignant obstructive jaundice in perioperative period. Methods The patients with malignant obstructive jaundice （serum bilirubin 〉 171 μmo]/L） in Bathune International Peace Hospital were collected from 1997 to 2003. Different quantities of fluid were supplied and the reduction of jaundice was observed. Results The total serum bilirubin reduced to less than 200μmol/L in 91.4% of the patients in fluid supplement group one week after operation. Compared with the control group,the time to 50% reduction of serum bilirubin in fluid supplement group was significantly shortened. If the biliary tract drainage was enough, the speed of jaundice vanishing in the fluid supplement group was not related to the primary disease or the kinds of operation in the short period. Analysis of the liver function indexes before and after operation showed that TB was significantly correlated with ALP,but TB and ALP were not correlated with other liver function indexes. The speed of jaundice vanishing was similar between urine volume in 24 hours less and more than 3000 ml in the first week after operation in fluid supplement group. Condusion The supplement of sufficient fluid is a rapid and effective way to promote reduction of obstructive jaundice and can prevent serious complication.

关 键 词：恶性梗阻性黄疸 围手术期 减黄术 

分 类 号：R735[医药卫生—肿瘤]