限制性输液在老年结直肠癌患者腹腔镜手术中的应用  

Application of restrictive fluid therapy in elderly patients undergoing laparoscopic colorectal surgery

作　　者：蒋金华[1] 程震[1] 余健[1] 张军[1] 高萍[1] JIANG Jinhua CHENG Zhen YU Jian et al(Department of Anesthesia, Taixing People＇s Hospital, Taixing 225400, CHIN)

机构地区：[1]泰兴市人民医院麻醉科,江苏省225400

出　　处：《江苏医药》2017年第12期857-859,共3页Jiangsu Medical Journal

摘　　要：目的观察限制性输液在老年结直肠癌患者腹腔镜手术中的应用效果。方法择期老年结直肠癌腹腔镜手术患者60例随机均分为两组,麻醉手术期间分别持续输注复方乳酸钠5ml·kg^(-1)·h^(-1)(A组)和25ml·kg^(-1)·h^(-1)(B组)。记录麻醉诱导前10min(T0)、诱导后10min(T1)、气腹头低位后10min(T2)、60min(T3)、90min(T4)和气腹消除平卧位15min(T5)的MAP、CVP、动脉血乳酸(LA)、中心静脉血氧饱和度(ScvO_2)和红细胞比积(Hct),检测T0、T2、T5和术后第1天(T6)、第3天(T7)和第5天(T8)血浆IL-6水平。结果两组T0~T3时的MAP、CVP、动脉血LA和Hct值均无统计学差异(P>0.05),各时点ScvO_2值亦相仿(P>0.05)。两组T2~T4时的CVP较T0增加(P<0.05);A组T5时的CVP值低于B组(P<0.05),T4、T5时的Hct值高于B组(P<0.05)。两组T3~T5时的LA均高于T0(P<0.05)。T5~T8时,A组的IL-6水平低于B组(P<0.05)。结论老年结直肠癌腹腔镜手术期间实施限制性输液可减轻炎症反应,有利于患者的术后康复。Objective To observe the outcomes of restrictive fluid therapy in elderly patients undergoing laparoscopic colorectal surgery.Methods Sixty patients undergoing selective laparoscopic colorectal surgery were randomly assigned into two groups with 30 cases each.During surgery,group A was infused lactated Ringer’s solution 5ml·kg-1·h-1 and group B was infused lactated Ringer’s solution 25ml·kg-1·h-1.The MAP,CVP,arterial lactic acid（LA）,central venous blood oxygen saturation（ScvO2）and hemotocrit（Hct）were recorded at 10 minutes before（T0）and 10 minutes after anesthesia induction（T1）,at 10 minutes（T2）,60 minutes（T3）and 90 minutes（T4）after pneumoperitoneum under Trendelenburg position and at 15 minutes after the end of pneumoperitioneum and Trendelenburg position（T5）.Plasma levels of IL-6were measured at T0,T2,T5,and on the 1st（T6）,2nd（T7）and 5th day（T8）after operation.Results There were no significant differences in MAP,CVP,arterial LA,ScvO2 and Hct at T0-T3 in both groups（P〉0.05）.The CVP was higher at T2-T4 than that at T0 in both groups（P〈0.05）,which at T5 was lower in group A than that in group B（P〈0.05）.The Hct at T4 and T5 was higher in group A than that in group B（P〈0.05）.Arterial LA in both groups was higher at T3-T5 than that at T0（P〈0.05）.Plasma IL-6 at T5-T8 was lower in group A than that in group B（P〈0.05）.Conclusion The restrictive fluid therapy in elderly patients undergoing laparoscopic colorectal surgery has an advantage of reducing inflammatory response to surgical injury,which is helpful in postoperative recovery.

关 键 词：限制性输液 腹腔镜 白细胞介素6 乳酸 

分 类 号：R614[医药卫生—麻醉学]