术中限制性输液对老年患者结肠癌术后呼吸机相关肺炎的影响  

Effect of restrictive transfusion in colon cancer surgery on postoperative ventilator-associated pneumonia in elderly patients

作　　者：孟杰[1] 陈丽[1] 肖航[1] 

机构地区：[1]湖北省孝感市中心医院,432000

出　　处：《实用医学杂志》2015年第17期2839-2841,共3页The Journal of Practical Medicine

摘　　要：目的：观察术中限制性输液对老年患者结肠癌术后呼吸机相关肺炎（VAP）的影响。方法：选择结肠癌择期手术的老年患者40例，随机分为限制性输液组（R组，n=20）和标准输液组（S组，n=20）。术中S组按照常规补液方案补液．R组前1h输入累计缺失量1／3，之后输液速度为4mL／（kg·h），维持中心静脉压（CVP）5～7cmH2O，可根据CVP调整输液速度或者使用利尿剂，不限制输液量。对比两组患者术中血乳酸（LAC）值：对比术中液体输入量、失血量、尿量和胸内液体量（TFC）；对比术前及术后1、3、7d患者的临床肺部感染评分（CPIS）来评估呼吸机相关肺炎（VAP）的风险。结果：R组和S组术中MAP、HR、CO、尿量比较差异无显著性（P〉0．05），R组输液量明显少于s组（P〈0．05），术后TFC明显小于s组（P〈0．05），术后1、3、7d临床肺部感染评分（CPIS）小于S组（P〈0．05）。结论：术中限制性输液可减少老年患者结肠癌术后呼吸机相关肺炎的发生率，且不影响患者术中的循环和组织灌注。Objective To observe the effect of restrictive transfusion in colon cancer surgery in elderly patients on postoperative VAP （ventilator-associated pneumonia）. Methods Forty cases of elderly patients with colon cancer intending to undertake surgery were randomly divided into restrictive transfusion group （group R） and standard transfusion group （group S） with 20 cases in each group. In group R, patients were administered one third of accumulative fluid loss in the first 60 minute, then the infusion rate were 4 mL/（kg· h） and central venous pressure was maintained at 5 - 7 cmH2O. In group S, rate of fluid administration = CVE ＋ deficit ＋ maintenance ＋ loss ＋ third space. Blood gas index including lactic acid and volumes of fluid administered, blood loss, urine volume and thoracic fluid count （TFC） were recorded in the operation. Clinical pulmonary infection score（CPIS） was recorded respectively before operation, 1 day, 3 day, 7 day after operation to evaluate the risk of VAP. Results Compare with those in group S, there were significantly less TFC and intraoperative volumes of fluid administration in group R. The CPIS was significant lower at day1, day3, day7 after operation in group R. There was no significant difference in MAP, HR, CO and urine volume between two groups. Conclusions In colon cancer surgery for elderly patients, restrictive transfusion can maintain hemodynamic stability, ensure the tissue oxygenation, reduce conjunction edema, shorten the recovery and hospital stay and reduce the incidence of VAP.

关 键 词：限制性输液 老年患者 结肠癌手术 呼吸机相关肺炎 

分 类 号：R735.35[医药卫生—肿瘤]