术后限制性液体管理对结肠部分切除术后患者胃肠功能恢复的影响  

Effects of postoperative restrictive fluid management on recovery of gastrointestinal function after elective colonic resection

作　　者：刘畅[1] 饶群[1] 李建国[1] 杜朝晖[1] 周青[1] 梁辉[1] 胡波[1] 李璐[1] 王静[1] 蔡书翰[1] 

机构地区：[1]武汉大学中南医院重症医学科,湖北430071

出　　处：《中国危重病急救医学》2012年第9期526-529,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金项目（30972852）;湖北省自然科学基金计划项目（2009CDB091）

摘　　要：目的探讨保证组织灌注前提下的术后限制性液体管理对结肠部分切除术后患者胃肠道功能恢复的影响。方法30例结肠部分切除术后患者，经6h复苏后按随机数字表法分为限制性液体管理组（限制组）和常规液体管理组（对照组），每组15例。自手术结束当日至术后4d，限制组和对照组患者液体总入量分别控制于25—35ml·kg^-1·d^-1和40～50ml·kg^-1·d^-1，监测两组患者液体平衡、组织灌注、胃肠道功能恢复时间和水、电解质紊乱发生情况。结果限制组患者液体总入量（ml／d）和液体净平衡（ml／d）明显少于对照组（总人量：1782．56±258．38比2707．50±294．64，净平衡：316．67±202．86比623．33±244．38，均P〈0．05），中心静脉压（CVP，mmHg，1mmHg=0．133kPa）明显低于对照组（4．03±1．81比6．47±3．09，P〈0．05），心率（HR，次／min）、平均动脉压（MAP，mmHg）与对照组比较则差异无统计学意义（HR：85．03±13．49比81．44±12．49，MAP：80．65±11．39比82．38±8．28，均P〉0．05）。限制组患者术后第1个24h乳酸清除率高于对照组[35（17，53）％比17（-6，33）％，P〈0．05]，患者肠鸣音及肛门排气、排便恢复时间（h）均明显短于对照组（肠鸣音：37．43±24．97比46．36±19．34，排气：53．63±12．78比75．43±20．07，排便：78．73±46．48比93．40±41．08，均P〈0．05），发生术后呕吐的例次数明显少于对照组（2比7，P〈0．05）。而限制组和对照组患者出现电解质紊乱（5比3）、容量缺乏（2比0）、容量过多（0比1）的例次数则无差异。结论对行结肠部分切除术的患者，术后保证组织灌注前提下减少液体正平衡，可以缩短患者术后胃肠道功能恢复时间，不增加水、电解质紊乱的发生。Objective To investigate the effect of postoperative restrictive fluid management by ensuring adequate tissue perfusion on the recovery of gastrointestinal function after elective colonic resection. Methods Thirty patients suffered with elective colonic resection, after 6 hours of anesthesia recovery, were randomly divided into restrictive fluid management group （restrictive group, n = 15 ） and traditional fluid management group （control group, n = 15 ）. From the surgery day to the 4th postoperative day, patients in restrictive group and control group received the total fluids of 25-35 ml · kg^-1·d^-1 or 40-50 ml · kg-1·d-1 respectively. Fluid balance, tissue perfusion, gastrointestinal function recovery time and the imbalance of fluid and electrolyte were recorded. Results The total fluid input （ml/d） and net fluid balance （ml/d） in restrictive group were significantly fewer than those in control group （total fluid input： 1782.56 ± 258.38 vs. 2707.50 ± 294.64, net fluid balance： 316.67 ± 202.86 vs. 623.33 ± 244.38, both P〈0.05）, and central venous pressure （CVP, mm Hg, 1 mm Hg=0.133 kPa） was significantly lower than that in control group （4.03 ± 1.81 vs. 6.47 ± 3.09, P〈0.05 ）. There were no differences in heart rate （HR, bpm） and mean arterial pressure （MAP, mm Hg） between two groups （HR： 85.03± 13.49 vs. 81.44 ± 12.49, MAP： 80.65 ± 11.39 vs. 82.38 ＋ 8.28, both P〉O.05 ）. The lactate clearance rate of the first postoperative 24 hours in restrictive group was higher than that in control group [35 （ 17, 53）% vs. 17 （-6, 33）%, P〈0.05 ]. The times （hours） of bowel sounds recovery, the first flatus and stool passed in restrictive group were shorter than those in control group （bowel sounds： 37.43 ±24.97 vs. 46.36 ± 19.34, flatus： 53.63 ±12.78 vs. 75.43 ±20.07, stool： 78.73 ±46.48 vs. 93.40 ±41.08, all P〈0.05）. Vomiting was reduced in the restrictive group compared with control group （2 vs. 7, P〈0.05）. There were

关 键 词：限制性液体管理 组织灌注 术后胃肠道功能障碍 结肠部分切除 水、电解质紊乱 

分 类 号：R619[医药卫生—外科学]