高渗盐水对胃肠道癌术后液体平衡和临床结果的影响

Effects of hypertonic saline on fluid balance and clinical outcome after radical surgery for gastrointestinal carcinoma

目的探讨7.5%高渗盐水对胃肠道癌术后液体平衡和临床结果的影响。方法对2003～2004年52例胃肠道癌根治性切除术病人,术毕进入外科ICU后,研究组(n=26)输注7.5%高渗盐水(4mL/kg)后续平衡液;对照组(n=26)仅输平衡液。比较两组病人的输液量、尿量、液体平衡、体重变化、动脉血氧分压/吸氧浓度分数(PaO2/FiO2)比值,以及并发症发生率和病死率。结果与对照组相比,研究组手术日和术后第1日的尿量较多,输液量减少;术后48h的液体正平衡量减少;术后体重增加幅度降低,PaO2/FiO2比值较高,总体并发症发生率和肺部感染发生率较低。结论7.5%高渗盐水有明显的利尿作用,可减少胃肠道癌术后的输液量和液体正平衡量,促进液体负平衡提前出现,并使术后总体并发症发生率和肺部感染发生率降低。

Objective To investigate the effects of 7.5% hypertonic saline on fluid balance and clinical outcome after radical surgery for gastrointestinal carcinoma.Methods 52 patients with gastrointestinal carcinoma undergoing radical surgery were studied.The patients were assigned to receive either Ringer lactate solution following 4mL/kg of 7.5% hypertonic saline (the experimental group,n=26) or Ringer lactate solution (the control group,n=26) during the early postoperative period in SICU.Fluid infusion volumes,urine outputs,fluid balance,body weight change,PaO2/FiO2 ratio as well as the incidence of complication and mortality were compared between the two groups.Results Urine outputs on the operative day and the first postoperative day in experimental group were significantly more than that in control group.Fluid infusion volumes on the operative day and the first postoperative day were significantly lesser in experimental group than in control group.The volumes of the positive fluid balance during first 48 hours after surgery in experimental group were significantly lesser than that in control group.Body weight gain after surgery were significantly lower in experimental group than in control group.PaO2/FiO2 ratio after surgery is higher in experimental group than in control group.The overall incidence of complication and the incidence of pulmonary infection were lower in experimental group than in control group.Conclusion 7.5% hypertonic saline has an intense diuretic effect,which could reduce fluid infusion volumes and positive fluid balance after radical surgery for gastrointestinal carcinoma as well as accelerate negative fluid balance appearance more early after the surgery,and make the overall incidence of complication and the incidence of pulmonary infection incidence after the surgery lower.