多目标导向的腹膜后肿瘤围手术期补液策略  

Mutilpe goals directed periopertive fluid strategy in patients of retroperitoneal tumors

作　　者：张柳[1] 程蔚新[2] 袁宏勋[2] 沈剑[2] 刘芳[2] 朱凤雪[1] 安友仲[1] 

机构地区：[1]北京大学人民医院重症医学科,100044 [2]北京大学国际医院重症医学科

出　　处：《中华普通外科杂志》2016年第10期824-827,共4页Chinese Journal of General Surgery

摘　　要：目的 总结腹膜后肿瘤围手术期的液体治疗经验,探索围手术期补液策略.方法 回顾性分析北京大学人民医院和北京大学国际医院89例腹膜后肿瘤围手术期液体治疗、出入量、血清脑利钠肽（brain natriuretic peptide,BNP）水平及并发症,分为小出血组（761 ml）和大出血（4 813 ml）组.结果 小出血组在手术日、术后第1、2、3天补液量分别为（7565±4757）、（3 869±727）、（3 289±897）、（3 096±567） ml,大出血组依次为（13 927 ±5 612）、（5 192±1 274）、（3786±1 137）、（3 797 ±719） ml（t=-4.637、-3.117、-2.460、-2.982,P=0.04、0.048、0.36、0.038）.小出血组BNP水平分别为（33±25）、（82±66）、（116±54）、（145±75） ng/ml,大出血组依次为（70 ±65）、（165±153）、（256±220）、（442±412） ng/ml（t=4.637、-3.117、-2.460、-2.982,P=0.041、0.038、0.046、0.04）.术后3d累计出现自然负平衡的概率为100％.术后并发症主要有急性肾损伤、心脏事件、呼吸事件、腹腔事件、深静脉血栓等,在小出血组和大出血组发生率分别为4.7％、7.1％、4.7％、14.3％、9.5％和25.1％、27.6％、46.8％、10.6％、17.0％（x2=2.89、5.89、19.96、0.044、0.674,P=0.049、0.015、0.001、0.834、0.412）.结论 多目标综合导向的液体策略可获得良好预后,降低了整体术后急性肾损伤发生率;术后可用BNP作为监测补液量的标志物.Objective To evaluate perioperative fluid infusion strategies in retroperitoneal tumor patients.Method Data of 89 retroperitoneal tumor patients in Peking University People＇s Hospital and Peking University International Hospital were collected and devided into intraoperative minor haemorrhage group （761 ml） and massive haemorrhage group （4 813 ml）,including postoperative fluid treatment,input and output volume,serum brain natriuretic peptide level and postoperation complications.Results Fluid input on the 1st day after operation,the 2nd day,the 3rd day respectively were （7 565 ±4 757）,（3 869 ± 727）,（3 289 ± 897）,（3 096 ± 567） ml in the minor haemorrhage group,and （13 927 ± 5 612）,（5 192 ± 1 274）,（3 786 ± 1 137）,（3 797 ± 719） ml in the massive haemorrhage group （t =-4.637,-3.117,-2.460,-2.982,P =0.04,0.048,0.36,0.038）.BNP level respectively were （33 ±25）,（82 ±66）,（116 ± 54）,（145 ± 75） ng/ml in the minor haemorrhage;respectively,（70 ± 65）,（165 ± 153）,（256 ± 220）,（442 ± 412） ng/ml in the massive haemorrhage group （t =-4.637,-3.117,-2.460,-2.982,P =0.041,0.038,0.046,0.04）.The accumulative percentage of negative fluid balance was 100% in 3 days after operation.Acute kidney injury （AKI）,cardiac,respiratory events,major intraabdominal complications deep venous thrombosis developed in minor and massive haemorrhage group were 4.7%,7.1%,4.7%,14.3%,9.5% vs.25.1%,27.6%,46.8%,10.6%,17.0% respectively （x2 =2.89,5.89,19.96,0.044,0.674,P=0.049,0.015,0.001,0.834,0.412）.Conclusions Multiple goals directed fluid strategy leads to a better outcome by decreasing the AKI rate.BNP level could be used as a goal marker in fluid treatment.

关 键 词：腹膜后肿瘤 利钠肽 脑 围手术期 液体治疗 

分 类 号：R735.4[医药卫生—肿瘤]