摘要
目的探讨目标导向液体治疗下不同输液方案对颅脑手术病人胶体渗透压及预后的影响。方法 ASAⅠ~Ⅲ级拟行颅内肿瘤切除手术病人61例,随机分为3组,A组(晶胶比例2∶1)21例,B组(晶胶比例1∶1)21例,C组(晶胶比例1∶2)19例。在Vigileo监护仪指导下根据每搏量变异度(SVV)指导液体治疗。术中监护病人的心率(HR)、平均动脉压(MBP)、心输出量(CO)、心指数(CI)和每搏变异度(SVV)。分别于麻醉诱导后即刻(T1)、手术开始1小时(T2)、手术结束前10分钟(T3)、手术结束后12小时(T4)、24小时(T5)、48小时(T6),从病人的右锁骨下静脉抽得混合中心静脉血,利用BMT923COP仪测血浆胶体渗透压(COP)及血气结果。记录术中输液、术后脱机拔管时间、神经外科重症监护室(NICU)停留时间以及住院时间、病人恢复质量评分(QOR-40)、脑水肿、呕吐等并发症的发生率。结果 3组均能维持血流动力学的平稳。在T3点,C组COP值的下降幅度为(0.98±1.63)mm Hg,A组的下降幅度为(2.78±2.25)mm Hg,两者间比较差异有统计学意义(P<0.05)。T2~T6时间点Hb及Hct与T1点比较明显下降,差异有统计学意义(P<0.05)。乳酸值在T4、T5水平明显升高,T5点达到峰值,差异有统计学意义(P<0.05)。结论在目标导向的液体管理下,低晶胶比的液体输注方案更有助于维持病人围术期COP的稳定,但对病人预后及并发症的出现无明显影响。
Objective To investigate the changes of plasma colloid pressure（ COP） and the outcome of neurosurgical patients under different crystal and colloid ratio infusion during the operation. Methods A total of sixty-one ASA Ⅰ ~ Ⅲ patients scheduled for neurosurgery were randomly divided into three groups. The ratios of crystalloid versus colloid were 2∶ 1,1∶ 1 and 1∶ 2 in group A,B and C,respectively. All groups received GDT according to stroke volume variation（ SVV）,guided by vigileo monitor.Blood samples were taken from the right subclavian vein at induction（ T1）,1 h after the beginning of operation（ T2）,10 mins before the end of the operation（ T3）,12 h after operation（ T4）,24 h after operation（ T5）,48 h after operation（ T6）. The colloid osmotic pressure and blood gas were measured by BMT923 COP. The HR,MBP,CO,CI and SVV were monitored during the operation. The intraoperative transfusion,the hospital stay,the quality of recovery score and the occurrence of complications were recorded. Results Three groups maintained the hemodynamic stability during the operation. The decrease of the plasma COP were significantly in group A（ 2. 78 ± 2. 25 mm Hg） than that in group C（ 0. 98 ± 1. 63 mm Hg） at T3（ P〈0. 05）. The plasma COP,Hb and Hct at T2 ~ T6 were significantly decreased（ P〈0. 05）,the lactic acid at T4 ~ T5 were significantly increased（ P〈0. 05）. There was no significant difference in the ventilator use time,hospital stays,quality of recovery scores as well as occurrence of complications（ P〈0. 05）. Conclusions Under goal-directed fluid therapy,the liquid infusion regimen with low crystalloid ratio is more conducive to maintain the stability of COP during perioperative period,while it has no significant effect on the prognosis and complications.
作者
吕蔓蔓
杨辉
柴小青
刘凌云
LV Manman;YANG Hui;CHAI Xiaoqing;et al(Department of Ancsthesiology , Anhui provincial hospital, Hefei 230001, China)
出处
《临床外科杂志》
2018年第1期68-71,共4页
Journal of Clinical Surgery
关键词
渗透压
血浆
液体治疗
颅脑手术
osmotic pressure
plasma
fluid therapy
surgery
