生物电阻抗法用于重大手术患者手术期间输液方案的评估  

Assessment of transfusion plans by using bioelectrical impedance during abdominal major surgery

作　　者：钟颖[1] 马莉[1] 陈文栋[1] 毕春[1] 

机构地区：[1]昆明医学院第一附属医院麻醉科,昆明市650032

出　　处：《河北医药》2010年第12期1509-1511,共3页Hebei Medical Journal

基　　金：云南省教育厅基金资助项目(编号:06Y227C)

摘　　要：目的通过多频生物阻抗分析仪测定观察肺叶切除术手术期间不同输液方案下体液的分布,特别是临床上难以测定的有效循环血量之外的细胞外液的变化,为重大手术期间制定更合理、安全的输液方案,保证手术患者术中、术后有更稳定的内环境及良好的器官功能。方法 63例行胸外科手术患者随机分为A组(常规输液组,28例),B组(限制输液组,35例)。A组:手术期间输注复方乳酸钠林格氏液12～14ml.kg-1.h-1;B组:手术期间输注LR液6～8ml.kg-1.h-1。用多频生物阻抗分析仪监测手术期间患者的总体液量(TBW)、细胞内液(ICW)、细胞外液(ECW)。结果 2组术前后水含量:手术结束时,常规输液组细胞内、外液和全身水量均增加,其中细胞外液和全身水量增加更为明显,限制输液组细胞内、外液和总体液量在术前、术后变化不明显。Hct、pH值、K+、Na+2组差异无统计学意义(P>0.05)。结论在择期胸外科手术中使用两种输液方案均能维持较为正常的生命体征和内环境,但传统输液组细胞外液量有增多趋势。Objective To observe the distribution of body fluid during pulmonary lobectomy by using different transfusion plans detected by multiple -frequency bioelectrical impedance analyzer, especially when the change of extraceltular fluid is difficult to be measured besides effective circulating blood volume. Through the analysis, we can make more rational,safer plan, assure patients to have a steady internal environment and better organ function during the operation and after operation. Methods 63 adult patients undergoing pulmonary lobectomy and having no disorders of heart, lung, kidney, electrolyte disturbance, anemia and abnormal blood volume were enrolled in the investigation, and the operation lasted more than three hours. The patients were divided into routine fluid group （Group A, n =28）and limited fluid group（ Group B, n = 35 ）. Lactated Ringer solution （LR）was administered to the patients of group A at the rate of 12 - 14ml . kg-1. h-1 and LR solution was administered to the patients of group B at the rate of 6 - 8ml . kg-1. h-1 during operation. The the total body fluid（TBW）, the intracellular fluid （ ICW）, the extracellular fluid （ECW） were measured by using multiplefrequency bioelectrical impedance analyzer during operation. Results The TBW, ICW and ECW were increased in the routine fluid group at the end of operation. Conclusion Two transfusion plans can maintain the vital sign and internal environment, but the routine transfusion plan has the tendency of increasing extracellular fluid.

关 键 词：多频生物电阻抗分析仪 输液方案 体液评估 细胞外液 

分 类 号：R619[医药卫生—外科学]