肠癌根治术病人两种容量治疗方案效果的比较

Comparison of efficacy of two regimens of volume therapy in patients undergoing radical intestinal cancer operation

目的比较肠癌根治术病人麻醉诱导前6％羟乙基淀粉130／0．4-麻醉诱导后乳酸钠林格氏液血液稀释与麻醉诱导前乳酸钠林格氏液-麻醉诱导后6％羟乙基淀粉130／0．4血液稀释容量治疗的效果。方法拟行肠癌根治术病人40例，ASAⅠ或Ⅱ级，年龄45．64岁，体重42～65kg，随机分为2组（n=20），Ⅰ组麻醉诱导前经30min静脉输注6％羟乙基淀粉130／0．4 15ml／kg，麻醉诱导后即刻经30min静脉输注乳酸钠林格氏液15ml／kg；Ⅱ组于麻醉诱导前经30min静脉输注乳酸钠林格氏液15ml／kg，麻醉诱导后即刻经30min静脉输注6％羟乙基淀粉130／0．4 15ml／kg。记录术中胶体液量、晶体液量、出血量、尿量和异体输血情况；于入室后（基础状态，T0）、麻醉诱导后即刻（T1）、15min（T2）、60min（T3）、120min（T4）及术毕（T5）时记录平均动脉压（MAP）、中心静脉压（CVP）和心率（HR）；于T0，T1、T3、T5时抽取桡动脉血样1ml行血气分析，并测定血红蛋白浓度（Hb）和红细胞压积（Hct）。结果两组均未输异体血，术中胶体液用量、晶体液用量、出血量、尿量差异无统计学意义（P〉0．05）；与基础值比较，Ⅰ组术中MAP、HCO3^-、血浆乳酸、Na^＋、K^＋的浓度差异无统计学意义（P〉0．05），CVP升高，HR、Hct、Hb降低，术毕时pH值降低，Ⅱ组术中CVP升高，MAP、HR、pH值降低，术毕时HCO3^-降低（P〈0．05），血浆乳酸、Na^＋、K^＋的浓度差异无统计学意义（P〉0．05）；与Ⅰ组比较，Ⅱ组术中CVP升高，术毕时血浆乳酸浓度降低（P〈0．05）。结论肠癌根治术病人采用麻醉诱导前6％羟乙基淀粉130／0．4-麻醉诱导后乳酸钠林格氏液血液稀释的容量治疗效果较好。

Objective To compare the efficacy of two regimens of volume therapy in patients undergoing radical intestinal cancer operation. Methods Forty ASA Ⅰ or Ⅱ patients, aged 45-64 yr, weighing 42-65 kg, scheduled for radical intestinal cancer operation, were randomly divided into group Ⅰ and group Ⅱ （ n = 20 each）. In group Ⅰ , 6% hydroxyethyl starch 130/0.4 （HES） 15 ml/kg was infused iv over 30 min before anesthesia induction, and lactated Ringer＇s solution 15 ml/kg was infused iv over 30 min immediately after anesthesia induction for hemodilution. In group Ⅱ , lactated Ringer＇s solution 15 ml/kg Was infused iv over 30 min before anesthesia induction, and HES 15 ml/kg was infused iv over 30 min immediately after anesthesia induction for hemodilution. Intraoperative infusion of colloid and crystalloid, blood loss, urine output and allogeneic blood transfusion were recorded. MAP, CVP and HR were recorded after entering the operating room （T0, baseline）, and at 0, 15, 60 and 120 min after anesthesia induction （T1-4）, and at the end of operation （T5 ）. Blood samples were taken from radial artery at T0 , T1 , T3 and T5 for blood gas analysis and determination of Hb and Hct. Results Allogeneic blood was not transfused in both groups. There were no significant differences in infusion of colloid and crystalloid, blood loss, and urine output between the two groups （ P 〉 0.05）. Compared with the baseline value, no were significant changes in intraoperative MAP, HCO3^- , concentrations of lactate, Na^＋ and K^＋ were detected （ P 〉 0.05 ）, while CVP was significantly increased, and HR, Hct, Hb, and pH value at the end of operation were significantly decreased in group Ⅰ. Compared with the baseline value, intraoperative CVP was significantly increased, and MAP, HR, pH value, and HCO3^- at the end of operation were significantly decreased, while no significant changes in concentration lactate, Na^＋ and K^＋ were detected in group Ⅱ （ P 〉 0.05 ）. Intraoperative CVP was significantly higher and lactate concentration at the end of operation significantly lower in group Ⅱ than in group Ⅰ . Conclusion The efficacy of volume therapy with HES before anesthesia induction and lactated Ringer＇s solution after anesthesia induction for hemodilution is better.