摘要
目的探讨联合麻醉下目标导向液体治疗对炎症细胞因子的影响。方法选择60例行肠道肿瘤手术的患者,性别不限,年龄60~85岁,ASA分级Ⅱ~Ⅲ级,随机分为目标导向液体治疗组(G组,n=30)和常规补液组(C组,n=30)。记录入室吸氧5 min(T1)、手术开始(T2)、手术开始1 h(T3)、手术结束(T4)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、BIS值,记录T2~T4时刻SVV数值。于T1、T3、T4抽取中心静脉血2 m L检测血清TNF-α、IL-6浓度。记录术中输液量、出血量、手术时间、排气时间、术后住院时间。结果 G组晶体液量、液体总量均比C组少(P<0.05),G组CVP、SVV变化更平稳。G组血清TNF-α、IL-6的浓度明显低于C组(P<0.01)。G组排气时间和术后住院时间均比C组短(P<0.01)。结论目标导向液体治疗可更精确的控制液体量,减少IL-6、TNF-α的释放,加快患者术后胃肠道功能恢复和总体恢复,是一项更好的液体管理策略,适合在联合麻醉围术期应用。
Objective To investigate effects of goal-directed fluid therapy on inflammatory cytokines under combined anesthesia. Methods 60 patients undergoing eolorectal cancer surgery, aged 60 to 85 years old, which were classified as American Society of Anesthesiology （ASA） class Ⅱ -Ⅲ , were randomly assigned to Goal-directed fluid therapy group（group G, n = 30） and central venous pressure liquid management group（group C, n = 30）. Life sign and BIS indexes were collected at the time points, before surgery （%） , after the start of the operation （%）, one hour after surgery（T3）, after the operation（%）. Hemodynamic indexes were recorded. Two milliliter blood sample were phlebotomized for evaluation of TNF-α and IL-6 from each patient at T1, T3, T4. The infusion volume, the amount of bleeding, the operation time, anal exhaust time, and length of postoperative hospital stay were recorded. Results Comparing information between the two groups, infusion volume and colloid had an obvious decrease than that of group C （P 〈 0.05）. SVV and CVP of group G were much stable than group C. The levels of TNF-α and IL-6 of group G were lower than those of group C （P 〈 0.01 ）. The length of anal exhaust time and postoperative hospital stay group G were faster than that of group C （P 〈 0.01 ）. Conclusions Goal-directed fluid therapy is superior on fluid administration. It can reduce the release of IL-6 and TNF-α. It is beneficial to elderly colorectal cancer patients with hypertension.
出处
《实用医学杂志》
CAS
北大核心
2018年第4期604-608,共5页
The Journal of Practical Medicine
基金
河北省政府资助临床医学优秀人才培养和基础课题研究项目(编号:361036)
关键词
目标导向液体治疗
炎症细胞因子
每搏变异度
goal-directed fluid therapy
inflammatory cytokines
stroke volume variation
