目标导向液体治疗对脑膜瘤切除术患者脑代谢和手术后康复的影响  

Effect of goal-directed fluid therapy on cerebral metabolism and postoperative rehabilitation in patients with meningioma

作　　者：易勇[1] 周章明[1] 梁张[1] 

机构地区：[1]四川省都江堰市人民医院神经外科,都江堰611830

出　　处：《中国肿瘤临床与康复》2016年第8期925-928,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨目标导向液体治疗对脑膜瘤切除术患者脑代谢和手术后康复的影响。方法选取2007年8月至2015年8月间都江堰市人民医院收治的106例脑膜瘤患者,按照临床试验数字随机的方法将患者随机分为观察组和对照组,每组53例。观察组患者采用目标导向液体治疗,对照组患者采用常规的输液模式治疗,观察两组患者颈内静脉球部血氧饱和度、血氧分压、血氧含量、脑氧摄取率、乳酸含量和术后康复指标。结果观察组患者术中中心静脉压、平均动脉压和补液量均显著优于对照组,差异有统计学意义(P<0.05)。与诱导前比较,术中两组患者的血氧含量明显下降,而乳酸含量明显上升,差异均有统计学意义(P<0.05)。术中对照组患者的乳酸含量明显高于观察组,差异有统计学意义(P<0.05)。观察组患者术后24 h神经功能评分[(15.4±4.8)分]明显低于对照组[(18.1±2.4)分],差异有统计学意义(P<0.05)。两组患者出院时的卡氏体能状态评分[(81.9±6.1)分]明显高于术前[(70.1±7.0)分],差异有统计学意义(P<0.05);但两组间比较差异无统计学意义(P>0.05)。结论脑膜瘤切除术围手术期实施目标导向液体治疗,可稳定心指数,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,且可降低患者术后24 h神经功能缺损评分,但对早期生活质量无明显影响。Objective To discuss the effect of target guided fluid therapy on cerebral metabolism and postoperative rehabilitation in patients with meningioma. Methods From August 2007 to August 2015 in People＇s Hospital of Dujiangyan City,106 patients were selected and divided into observation group and control group,with 53 cases in each group. Patients in the observation group were treated with the goal-directed fluid therapy,and the control group were treated with routine infusion mode. Internal jugular bulb oxygen saturation,oxygen partial pressure,oxygen content,cerebral oxygen uptake rate and lactic acid content and operation after rehabilitation indexes of two groups were compared. Results The central venous pressure,mean arterial pressure and fluid infusion in the observation group were significantly better than those in the control group,and the difference was statistically significant（ P〈0. 05）. Compared with before induction,the blood oxygen content of the two groups decreased significantly,while the lactic acid content increased significantly,and the difference was statistically significant（ P〈0. 05）. The lactic acid content in the control group was significantly higher than that in the observation group,and the difference was statistically significant（ P〈0. 05）. 24 h neurological function score in the observation group [（ 15. 4 ± 4. 8）score]was significantly lower than that of the control group [（ 18. 1 ± 2. 4） score],and the difference was statistically significant（ P〈0. 05）. When discharged from hospital,the two groups of patients＇ physical condition score（ 81. 9 ± 6. 1） was significantly higher than that before operation（ 70. 1 ± 7. 0）,and the difference was statistically significant（ P〈0. 05）,but there was no significant difference between the two groups（ P〈0. 05）. Conclusions Using target oriented liquid therapy during the perioperative period for meningioma resection,can stable cardiac index and maintain effective circulating blood volume,so as t

关 键 词：脑膜瘤 目标导向液体治疗 脑代谢 康复 

分 类 号：R614[医药卫生—麻醉学] R739.45[医药卫生—外科学]