胸外术后毛细血管渗漏综合征补液治疗策略的临床研究  

Clinical study of fluid therapy strategy for capillary leak syndrome after thoracic surgery

作　　者：王家宁[1] 平伟[1] 樊晓武[1] 孙威[1] 祖育昆[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科,武汉430030

出　　处：《临床外科杂志》2016年第4期290-292,共3页Journal of Clinical Surgery

摘　　要：目的探讨胸外术后毛细血管渗漏综合征（CLS）补液治疗策略。方法29例胸外术后CLS患者按预后分为痊愈组和死亡组，按CLS病程分别统计术后早期（1—4天）和术后晚期（5～7天）患者日均平均动脉压（MAP）、中心静脉压（CVP）、血浆白蛋白（ALB）含量、尿量和胸液引流量作为疗效判断指标，统计日均晶体液、白蛋白、人工胶体和新鲜冰冻血浆使用，并分析两组补液策略差异。结果两组患者术后早期均存在低血容量和低白蛋白血症；治疗后痊愈组在术后晚期症状改善而死亡组继续恶化，其日均MAP、CVP、ALB、尿量均低于痊愈组，日均胸液引流量较高。痊愈组术后早期白蛋白和人工胶体使用量高于死亡组（P〈0．05），而晶体液和血浆使用量比较，差异无统计学意义（P〉0．05）；术后晚期痊愈组白蛋白、人工胶体、血浆和晶体液使用量均低于死亡组（P〈0．05）。结论胸外术后CLS补液治疗策略需根据病程分期进行，在术后早期充分补充白蛋白和人工胶体能够有效避免CLS持续进展。Objective To investigate the proper fluid therapy strategy for capillary leak syndrome （CLS） after thoracic surgery. Method A total of 29 patients suffered from CLS after thoracic surgery were enrolled and divided into recovery group and death group according to their prognosis. Clinical characteristics were retrospectively studied according to the CLS course, including early（ 1-4 days）and late （5- 7 days） postoperative periods. MAP, CVP, ALB concentration, urine volume, and drainage volume were analyzed as effect indexes. Amounts of crystalloid solution, albumin, artificial colloids and FFP were analyzed to compare the difference of fluid therapy strategy between the two groups. Result During the early postoperative period, all the 29 patients suffered from hypovolemia and hypoalbuminemia. The conditions of patients in therecovery group were improved during the late postoperative period, while the conditions of patients in death group even deteriorated. MAP, CVP, ALB concentration and urine volume were lower and drainage volume was higher in the death group than the recovery group. The amount of albumin and artifi- cial colloids were higher in the recovery group than that in the death group during the early postoperative period（ P 〈 0. 05 ）, while there was no difference in the amount of crystalloid solution and FFP between the two groups （P 〉 0.05 ）. During the late postoperative period, the amount of crystalloid solution, albumin, artificial colloids and FFP were all lower in the recovery group than those in the Death group（ P 〈 0.05 ）. Conclusion The fluid therapy strategy for CLS after thoracic surgery should be performed according to different periods of CLS. The administration of albumin and artificial colloids should be preferred in the early postoperative period in order to effectively prevent progression of CLS.

关 键 词：毛细血管渗漏综合征 胸外术后 补液治疗 

分 类 号：R655[医药卫生—外科学]