摘要
目的探讨围手术期目标导向液体治疗对老年患者术后认知功能的影响。方法选ASAⅡ~Ⅲ级,年龄≥65岁的老年胃肠肿瘤患者60例;按照随机原则分为2组,每组30人,常规补液组(C组,n=30),GDFT组(G组,n=30)。C组患者根据术中血压变化进行常规补液,维持平均动脉压60~11 mm Hg;G组行目标导向液体治疗(GDFT),通过APCO连续获取SVV、CI、SVI等指标。术中维持SVV2%~13%,CI 2.5~4.0 L/(min.m),SVI 35~47 ml/m^2,MAP 65~110 mm Hg。术中记录总液体入量、晶体量、胶体量、术中血流动力学不良事件,采用认知功能MMSE测定患者术后1 d、2 d、5 d认知功能,总住院天数、术后住院天数和医疗费用。结果胃肠肿瘤患者手术过程中,常规补液组患者,其总液体入量、晶体液用量、胶体液用量、尿量、失血量分别为(2 092±399)ml、(1 327±299)ml、(822±262)ml、(344±52)ml、(322±33)ml;目标导向液体治疗组患者总液体入量、晶体液用量、胶体液用量、尿量、失血量分别为(2 572±382)ml、(1 279±332)ml、(1 153±279)ml、(533±50)ml、(318±30)ml;经统计学分析,两组患者的总液体入量(t=4.76,P<0.05),胶体液用量(t=4.76,P<0.05),尿量(t=4.76,P<0.05)之间的差异存在统计学差异。结论胃肠肿瘤患者术中进行目标导向液体治疗,可以提高患者术后的心脏功能,提高麻醉安全性,但是对患者的认知功能影响不大。
ObjectiveTo evaluate the effect of goal-directed fluid therapy（GDFT）on postoperative cognitive function in the patients undergoing gastrointestinal tumor resection.Methods 60 patients of American Society of Anesthesiologists physical statusⅡor scheduled for elective cerebral glioma or meningioma resection,were randomly divided into 2 groups（n=30 each）using a random number table：GDFT group（group G）and conventional fluid therapy group（group C）.The mean arterial pressure was maintained at 65-110 mmHg,urine volume0.5 ml/kg/h,and central venous pressure at 8-12 cm H2O in group C.In group G,SVV was maintained at 2%-13%,CI at 2.5-4.0L/（min.m）,SVI at 35-47ml/m^2,MAP at 65-110mmHg.The requirement for crystalloid and colloid,urine volume,blood loss,and requirement for vasoactive agents were recorded during operation.Cognitive function MMSE was used to determine the cognitive function of 1D,2D and 5D after operation,the number of days of total hospitalization,the number of postoperative hospital days and medical expenses.Results During the operation of gastrointestinal cancer patients,the total liquid intake,the amount of crystal liquid,the amount of colloid fluid,the volume of urine and the amount of blood loss were（2092±399）ml,（1327±299）ml,（822±262）ml,（344±52）ml,（322±33）ml,respectively.The total liquid intake,the amount of crystal liquid,the amount of colloid fluid,the volume of urine and the amount of blood loss were（2572±382）ml,（1279±332）ml,（1153±279）ml,（533±50）ml,（318±30）ml,respectively.After statistical analysis,the total liquid intake of the two groups（t=4.76,P〈0.05）,the amount of colloid fluid（t=4.76,P〈0.05）,the difference of urine volume（t=4.76,P〈0.05）had statistical difference.ConclusionsFor gastrointestinal cancer patients,targeted fluid therapy during operation can improve postoperative cardiac function and improve anesthetic safety,but it has little effect on cognitive function of patients.
作者
刘晓宁
李娜
黄彦
Liu Xiaoning, et al.(Department of Anesthesiology, Huidong County People＇s Hospital, Huizhou 516300, Chin)
出处
《齐齐哈尔医学院学报》
2017年第22期2659-2661,共3页
Journal of Qiqihar Medical University
基金
惠州市科技计划项目申报书(2016y242)
关键词
胃肠道肿瘤
中药方剂
老年人
Gastrointestinal cancer
Traditional Chinese medicine prescription
Elderly
