急慢性炎症患者全身麻醉腹腔镜手术期间乳酸林格氏液体容量效应特征分析被引量：1

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摘要目的分析急慢性炎症患者全身麻醉腹腔镜手术期间乳酸林格氏液体(RL)在血管内外分布和血流动力学特征。方法选择40例ASAI-1I级。根据疾病种类、手术类型及炎症状态分为急诊阑尾切除术组(观察组,n=20)及慢性胆囊炎择期胆囊切除术组(对照组,n=20)。所有患者麻醉诱导前开始恒速输注RLI5 mL/kg,35 min内榆毕。采集输液开始后2 h内血标本和尿液标本,通过血红蛋白(Hb)稀释的方法计算输入液体血浆稀释(PD)、容量扩充量(VE)、容量扩充效率(VEE)以及血管外液体量(EVV);同时记录惠者动脉血压和心率。结果所有患者PD、VE在输液结束达到峰值,而VEE在输液开始达到峰值。输液后(40~120 min),观察组患者PD、VE和VEE均高于对照组(P<0.05);麻醉状态下PD和VE高于清醒状态(P<0.001)。观察组在清醒成麻醉状态,榆液期间及输液后,平均动脉压(MAP)和舒张压(DBP)低于对照组(P<0.001),而心率(HR)高于对照组(P<0.001)。结论急性炎症患者液体输注结束后,血浆稀释、容量扩充量以及容量扩充效率增加;而血流动力学表现为舒张压下降,心率增快,不受液体输注和麻醉影响,对急性炎雅患者液体治疗需要在血容量监测下进行个体化液体治疗方案。 Objeetive To investigate the distribution and hemodynamic characteristics of lactare Ringer's fluid(RL)in patients with acute infammation during laparoscopic surgery under general anesthesia.Methods This study was a contolled,prospective study.40 ASA 1-II patients were divided into two groups according to disease.operation type and inflammatory state:acute ppendicitis,emergency appendectomy(inflammatory group,n=20)or chronic cholecystitis elective cholecystectomy(control group,n=20).All patients were infused with LR at a constant rate of 15 mL/kg at a constant rate over 35 min before anesthesia induction.Blood and urine samples were cllected within 2 hours afer infusion.Plasma dilutions(PD),volume expansion(VE),volume expansion eficiency(VEE),and extravascular volume(EVV)were calculated based on the concentation of hemoglobin.Heart rate(HR)and artenal blood pesure were recorded.Results PD,VE peaked at the end of infusion,while VEE began to reach their peak at the begimning of infusion in all patients.After the infusion(40-120 min),PD,VE and VEE in the inflammation group were all higher than those in the control group(P<0.05),PD(P<0.001)and VE(P<0.001)were higher under anestheia than under consciousness.EVV and urine volume were comparable in both groups at the end of the trial.The mean aterial pressure(MAP)and diastolic pressure(DBP)in the inlammation group were sgnificandly lower(P<0.001)and heart rate(HIR)was significantly higher than(P<0001)control group under both anesthesia and consciouness,both during and after infusion.Conclusion PD,VE,and VEE are increased afer the completion of fluid infusion;while the hemodynamics show decreased DBP and increased HR not afcted by fluid infusion and anestheia in patients with acute inflammation.It sugges that the acute inflammatory patients should be treated with individualized fluid therapy under blood volume monitoring.