目标导向液体治疗对脑膜瘤切除术患者脑氧代谢的影响  

Effect of goal-directed fluid therapy on cerebral metabolism in patients undergoing meningioma resection

作　　者：袁柳青[1] 李凤仙[1] 刘世乐[2] 许睿[1] 张庆国[1] 徐世元[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,广州市510282 [2]佛山市顺德区第一人民医院

出　　处：《临床麻醉学杂志》2013年第4期317-321,共5页Journal of Clinical Anesthesiology

基　　金：贝朗麻醉科学研究基金(BB-2011-11)

摘　　要：目的比较目标导向液体治疗(GDFT)与常规输液方法对脑膜瘤切除术患者围术期脑氧代谢的影响。方法择期行仰卧位脑膜瘤切除术患者28例,随机分为两组:GDFT组(G组,n=15)和常规输液组(C组,n=13)。G组补偿性扩容量于麻醉诱导前30min内补充,术中以胸腔内血容积指数(ITBI)在800～1000ml/m2范围内为导向目标。采集动脉血与颈内静脉球部血检测血氧饱和度(SaO2、SjvO2)血氧分压(PaO2、PjvO2)、血氧含量(CaO2、CjvO2)、脑氧摄取率(CERO2)及乳酸含量(aLac、jvLac)。结果与诱导前比较,术中两组CaO2与CjvO2明显下降,而aLac与jvLac明显上升(P<0.05),且术中C组aLac和jvLac明显高于G组(P<0.05)。结论脑膜瘤切除术围术期以ITBI实施GDFT,能稳定心指数,维持有效循环血容量,从而保证脑灌注、改善微循环,降低脑乳酸生成率,不影响脑氧供需平衡。Objective To compare the effects of intraoperative goal-directed fluid therapy （GDFT） with routine means on cerebral oxygen metabolism in patients undergoing meningioma resection. Methods Twenty-eight patients undergoing supine position meningioma resection were randomly divided into 2 groups： routine fluid replacement group （group C, n= 13） and GI）FT group （group G, n= 15）. In group G, compensatory volume expansion was replaced before induction of anesthesia within 30 min. 6 - HES 130/0. 4 and diuretics were infused to maintain intrathoracic blood volume index （ITBI） between 800-1 000 ml/m2. Jugular bulb and arterial oxygen saturation （SaO2, SjvO2 ）, pressure （PaO2, PjvO2 ）, content （CaO2, CjvO2 ）, cerebral oxygen extraction rate （CERO2）, and lactate content （aLac, jvLac）were collected during operation. Results Compared with pre- induction, jugular bulb oxygen content （CjvO2）, arterial oxygen content （CaO2）, were significantly lower jugular bulb blood lactate （jvLac） and arterial blood lactate （aLac） were higher and reached the peak at 12 h postoperatively in two groups （P〈0. 05）. Intraoperatively the aLac and jvLac in group C were higher than in group G （P〈0. 05）. Conclusion GDFT guided with ITBI can not only maintain the effective circulating blood volume, but also ensure cerebral oxygen supply, improve microcirculation, reduce brain lactate production rate and without charge in the cerebral oxygen metabolism in intraoperation meningioma resection.

关 键 词：目标导向液体治疗 脑氧代谢 脑膜瘤切除术 

分 类 号：R614[医药卫生—麻醉学]