解放军医药杂志Issue(8)：88-93,6.DOI:10.3969/j.issn.2095-140X.2015.08.022
不同晶胶比例目标导向液体治疗对老年食管癌根治术患者围术期血管外肺水指数及血乳酸的影响
Effect of Goal-Directed Fluid Therapy with Different Crystalloid-Colloid Rations on Extravascular Lung Water Index and Blood Lactic Acid in Esophageal Cancer Patients Undergoing Esophagectomy
摘要
Abstract
Objective To investigate the effects of goal-directed fluid therapy ( GDFT) with different crystalloid-colloid ratios on extravascular lung water index and blood lactic acid in esophageal cancer patients undergoing esophagec-tomy. Methods A total of 50 esophageal cancer patients would undergo esophagectomy, and were randomly divided into low colloid radio group (group A, n=25) and high colloid radio group (group B, n=25) based on crystalloid-colloid ratio (3∶ 1) as the boundary line. All patients were given the one-lung mechanical ventilation and same surgical proce-dure during the surgery. The intraoperative fluid therapy was to maintain intrathoracic blood volume index ( ITBVI) with-in the normal range. The heart rate ( HR) , mean artery pressure ( MAP) , cardiac index ( CI) , extravascular lung water index ( EVLWI) and ITBVI were recorded using pulse indicator continuous cardiac output ( PiCCO) monitor before the operation ( T0 ) , 5 min after intubation ( T1 ) , 15 min after both lungs ventilation ( T2 ) , 15 min after one-lung ventilation ( T3 ) , 15 min after pulmonary re-expansion of both lungs ventilation ( T4 ) and at the end of operation ( T5 ) . Contents of blood lactic acid of all patients were measured before the operation, at the end of operation and 6 h after the operation. The usages of glucocorticoids, vasoactive drugs and Furosemide, the total volume of fluid, the volume of blood loss, uri-nary volume and the operation time were also recorded. Results There was no intraoperative use of glucocorticoid in the two groups. There were 1 patient with Furosemide and 1 with Phenylephrine in group A, and 2 patients with Phenyleph-rine in group B during the operation. A total of 46 cases were included in the statistical analysis, which included 23 cases in group A and 23 cases in group B. The intraoperative GDFT administration in the two groups could maintain stable he-modynamics. Compared with those at T0 , MAP and CI values in the two groups were significant decreased at T1 ( P<0. 05);CI value at T5 was significantly higher in group A (P<0. 05), and the value was significantly higher than that in group B (P<0. 05). EVLWI value at T5 in group B was significantly higher than that at T0 in the same group and at the same time point in group A (P<0. 05). Compared with those before the operation, there were no significant differences between the two groups in contents of blood lactic acid at each time point ( P>0. 05 ) . Content of blood lactic acid in group A was significantly lower than that in group B at the end of operation ( P<0. 05 ) . Conclusion GDFT with low crystal-colloid ratio can not only maintain intraoperative stable hemodynamics and improve tissue perfusion without in-creasing the risk of pulmonary edema in esophageal cancer patients undergoing esophagectomy.关键词
食管肿瘤/外科手术/目标导向液体治疗/血流动力学/血管外肺水指数/乳酸Key words
Esophageal neoplasms/Surgical procedures/Goal-directed fluid therapy/Hemodynamics/Extra-vascular lung water index/Lactic acid分类
医药卫生引用本文复制引用
刘娜,黄开明,王沛齐,徐悦利,李玲,路艳,李汝泓..不同晶胶比例目标导向液体治疗对老年食管癌根治术患者围术期血管外肺水指数及血乳酸的影响[J].解放军医药杂志,2015,(8):88-93,6.基金项目
承德市科学技术研究与发展计划(20142051) （20142051）
