限制性输液对老年开腹手术患者肝肾功能的影响  

Effects of Intravenous Fluid Restriction on Hepato-Nephro Function in Elderly Patients Undergoing Intra-Abdominal Surgery

作　　者：江朝秀[1] 倪玉霞[1] 刘春东[1] 刘敬臣[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,南宁市530021

出　　处：《广西医学》2013年第10期1295-1297,1300,共4页Guangxi Medical Journal

基　　金：广西自然科学基金(0832035)

摘　　要：目的探讨围术期限制性输液对老年开腹手术患者肝、肾功能的影响。方法将60岁以上择期行腹部手术患者60例按随机数字表法分为两组：S组30例为常规输液组，围术期按常规补液方案进行补液；R组30例为限制性补液组，麻醉诱导前至进腹1 h内补累积缺失量的1/2，之后每15 min测1次中心静脉压（ CVP），维持CVP的数值在5～7 cm H2 O，输液速度约为4 ml· kg ^-1· h^-1。两组晶、胶体输入比均为2∶1。比较两组术前、术后24 h肝、肾功能指标以及术后并发症、胃肠道恢复时间和术后住院时间。结果 R组液体输入总量显著少于S组（P＜0．05）。 R组术后血谷草转氨酶（AST）水平高于术前（P＜0．05），但尚处于正常范围；两组术后血谷丙转氨酶（ALT）、尿素氮、肌酐水平与术前比较，差异均无统计学意义（P＞0．05）；与S组比较，R组术后并发症发生率低，胃肠道功能恢复时间快，术后住院时间短（ P均＜0．05）。结论老年人腹部手术中采用限制性输液方案是安全可行的。Objective To explore the effects of intravenous fluid restriction on hepato-nephro function in eld-erly patients undergoing intra-abdominal operation .Methods Sixty patients older than 60 years who were undergoing elective operation on abdominal region were randomly divided into two groups ,30 cases in the standard group （ Group S） while 30 cases in the restriction group （ Group R） .In the standard group ,fluid management according to the stand-ard fluid administration was performed .In the restriction group ,patients were administered a half of accumulative fluid loss within one hour before anaesthesia induction , and their central venous pressure （ CVP ） , which ranged from 5 cmH2 O to 7 cmH2 O,was measured once every 15 minutes,the initial infusion rate was 4 ml· kg^ -1 · h^ -1 .The ratio of crystals input to colloid input was 2：1 in both groups .A comparison of the indices of hepato-nephro function before operation and 24 hours after operation as well as the postoperative complications ,the time of digestive tract function re-covery and length of stay was conducted between two groups .Results The total volume of fluid infusion in the Group R was significantly smaller than that in the Group S （P〈0.05）.The level of postoperative aspartate aminotransferase （AST） was higher than the preoperative one in the Group R （P〈0.05）,which also within the normal range;There was no significant difference in the alanine aminatransferase （ALT）,blood urea nitrogen（BUN）,creatinine（Cr） be-tween the preoperative and the postoperative in both groups （P〉0.05）;Compared with Group S,the incidence of postoperative complications was lower in the Group R as well as the time of digestive tract function recovery and length of stay were significantly shorter （all P〈0.05）.Conclusion Restrictive fluid management applied to elderly patients undergoing abdominal surgery is safe and feasible .

关 键 词：限制性输液 老年人 腹部手术 肝功能 肾功能 

分 类 号：R651[医药卫生—外科学]