高渗氯化钠羟乙基淀粉目标导向液体治疗应用于高龄患者腹腔镜直肠癌根治术  

Hypertonic Liquid Crystal Glue Goal-Directed Liquid Applied in Elderly Patients with Laparoscopic Colorectal Cancer Radical Treatment

作　　者：胡年春[1] 郑世嵘 屈兵 严虹[1] 

机构地区：[1]华中科技大学同济医学院附属武汉中心医院麻醉科,湖北武汉430010 [2]华润武钢总医院儿科(东区),湖北武汉430080 [3]华润武钢总医院普外科,湖北武汉430080

出　　处：《武汉大学学报（医学版）》2017年第4期654-658,共5页Medical Journal of Wuhan University

基　　金：武汉市卫计委科研项目(编号:WX16D36)

摘　　要：目的:观察目标导向液体治疗输注不同液体对高龄患者行腹腔镜直肠癌根治术(Dixon)手术中的临床应用。方法:52例限期腹腔镜直肠癌根治术(Dixon)手术,ASAⅠ-Ⅱ级,随机分为两组,均采用目标导向液体治疗:L组为乳酸林格液+万汶组;H组为乳酸林格液+高渗晶胶液组,每组26例。局麻下行两创测平均动脉压(MAP)、中心静脉压(CVP),监测毎搏变异度(SVV)、心输出指数(CI)等指标。两组根据SVV、MAP、CI、心搏量指数(SVI)将CI≥2.5L/(min·m^2)作为目标行目标导向液体治疗;监测并记录入室建立监测时(T0)、麻醉诱导平稳10min时(T1)、麻醉后1h(T2)、麻醉后2h(T3)、麻醉后3h(T4)、麻醉苏醒拔管后10 min(T5)的MAP、HR、CVP、CI、SVV以及记录手术时间、晶体液量、胶体液量、尿量、出血量、多巴胺使用量。结果:两组相比,H组液体输注量明显减少(P<0.05),而尿量明显增多(P<0.05);两组在T2、T3、T4、T5时CI、MAP、CVP逐步升高,与T1相比明显升高有显著性差异(P<0.05);而两组组间比较无明显差异性(P>0.05)。结论:腹腔镜直肠癌根治术(Dixon)手术麻醉期行目标导向液体治疗输注高渗晶胶液能有效扩容、稳定高龄患者的血流动力学,提高心输出量,改善微循环,增加尿量,减少第三间隙的水钠潴留,提高了目标导向液体治疗的安全性、合理性,减少高龄患者围术期的并发症。Objective： To observe the effect of goal-directed fluid therapy in laparoscopic radical rectectomy for rectal cancer （Dixon） when infusing different liquid in elderly patients. Methods： A total of 52 cases received selective laparoscopic radical rectectomy for rectal cancer （Dixon）, ASA Ⅰ - Ⅱ level, were randomly and equally divided into two groups for different goal-directed liquid infusion with lactic acid ringer solution plus Voluven （group L） or with lactic acid ringer solution plus hypertonic crystal glue （group H）. Mean arterial pressure （MAP）, central venous pressure （CVP）, stroke volume variation （SVV）, cardiac output index （CI）, etc. , were recorded and compared between the two groups. Both groups receive goal-directed fluid therapy based on SVV, MAP, CI, heart stroke volume index （SVI） with the goal of CI no less than 2.5 L/（min ·m2）. The variation of MAP,HR,CVP,CI and SVV at the onset of the monitoring（T1）,the moment after anesthesia induction （T2） ,the beginning of surgery（T3）, one hour after surgery （T4） and the end of the surgery （T5） were recorded. Results： The fluid infusion volume decreased significantly （P〈0.05）, and urinary output increased significantly （P〉0.05） in group H than that in group L; CI, MAP, and CVP increased gradually in both groups at T2, T3, T4, and T5（P〉 0.05）, but there was no differences between both groups （P〉0.05）. Conclusion： Goal-directed fluid therapy optimizes the cardiac preload effectively in elderly patients udergoing laparoscopic radical rectectomy for rectal cancer, improves cardiac output, guarantees the perfusion of microcirculation as well as increases urine output, and reduces the water sodium retention in third gap of body.

关 键 词：高渗晶胶液 目标导向液体治疗 腹腔镜直肠癌根治术(Dixon) 第三间隙 

分 类 号：R614.4[医药卫生—麻醉学]