限制性液体治疗在儿童脊髓拴系手术中的应用  

Application of Restricted Fluid Therapy in Tethered Spinal Cord Surgery in Children

作　　者：孙鑫 谢红[2] 王杭州[3] 王谦[1] SUN Xin;XIE Hong;WANG Hang-zhou;WANG Qian(Department of Anesthesiology,Children's Hospital of Soochow University,Suzhou,Jiangsu,215003,China;Department of Anesthesiology,Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215004,China;Department of Neurosurgery,Children's Hospital of Soochow University,Suzhou,Jiangsu,215003,China)

机构地区：[1]苏州大学附属儿童医院麻醉科,江苏苏州215003 [2]苏州大学附属第二医院麻醉科,江苏苏州215004 [3]苏州大学附属儿童医院神经外科,江苏苏州215003

出　　处：《中国血液流变学杂志》2022年第4期561-564,共4页Chinese Journal of Hemorheology

摘　　要：目的探讨术中限制性补液和非限制性补液对脊髓拴系综合征患儿术中各项指标的影响,为该手术的临床液体管理提供理论依据。方法2020年08月—2022年02月于苏州大学附属儿童医院行后路脊髓拴系松解+椎管内脂肪瘤切除+硬脊膜修补术+椎管扩大术的100例先天性脊髓拴系患儿,根据术中补液的实际情况按照纳入排除标准得到:限制性补液组(补液差异率<-10%,n=49)及非限制性补液组(补液差异率≥10%,n=23)。结果2组患儿术后乳酸水平、BE值差异无统计学意义(P>0.05),限制性补液组患儿实际补液量、尿量、术后HCT低于25%的发生率明显小于非限制性补液组,差异具有统计学意义(P<0.05)。T2时限制性补液组平均动脉压大于非限制性补液组,心率低于非限制性补液组,差异具有统计学意义(P<0.05)。结论限制性液体治疗更适合脊髓拴系综合征的患儿,既保证患儿术中血流动力学稳定和组织灌注,又有效降低了稀释性低HCT的发生率。Objective To investigate the effects of intraoperative restricted fluid rehydration and unrestricted fluid rehydration on intraoperative indicators in children with tethered cord syndrome,so as to provide a theoretical basis for clinical fluid management in this type of surgery.Methods From August 2020 to February 2022,100 children with congenital tethered spinal cord who underwent posterior tethered cord release+intraspinal lipoma resection+dural repair+spinal canal enlargement in Children's Hospital of Soochow University were included in the study.According to the inclusion and exclusion criteria,the results were as follows:the restricted rehydration group(rehydration difference rate<-10%,n=49)and the non-restricted rehydration group(rehydration difference rate≥10%,n=23).Results There was no significant difference in postoperative lactate level and BE value between the two groups(P>0.05).The actual fluid volume,urine volume,and the probability of postoperative HCT lower than 25%in the restricted rehydration group were significantly lower than those in the non-restricted rehydration group(P<0.05).At T2,the mean arterial pressure of the restricted rehydration group was higher than that of the non-restricted rehydration group,and the heart rate was lower than that of the non-restricted rehydration group,the differences were statistically significant(P<0.05).Conclusion Restrictive fluid therapy is more suitable for children with tethered cord syndrome,which not only ensures hemodynamic stability and tissue perfusion during operation,but also effectively reduces the incidence of low-dilution HCT.

关 键 词：限制性补液 限制性液体治疗 儿童脊髓拴系综合征 

分 类 号：R614[医药卫生—麻醉学]