摘要
目的评价不同容量治疗方法对肝癌切除术患者炎性反应的影响。方法择期行肝癌切除术患者40例,性别不限,年龄40~60岁,体重指数20—25kg/m2,AsA分级I或Ⅱ级,采用随机数字表法,将其随机分为2组(n=20):常规补液组(I组)和目标管理补液组(Ⅱ组)。I组补液量为补偿性扩容量+生理需要量+累计缺失量+继续损失量+第三间隙丢失量,补偿性扩容量于麻醉诱导前以乳酸钠林格氏液补充,补液量为5ml/kg,继续损失量按失血量计算,以HES130/0.4等量补充,第三间隙丢失量采用乳酸钠林格式液以5ml·kg·^-1·h^-1补充,生理需要量与累计缺失量根据4—2.1法则以乳酸钠林格式液补充。Ⅱ组补偿性扩容量于麻醉诱导前补充,方法同I组,麻醉诱导后静脉输注乳酸钠林格氏液5ml·kg·^-1·h^-1,同时根据每搏量(SV)和校正左室射血时间(LVETc)指导补液,维持LVETc350~400ms;350ms〈LVETc〈400ms,且SV增加幅度〉10%时,则继续静脉输注6%HES 130/0.4,直至SV增幅≤10%。于麻醉诱导前和术毕时取静脉血样,测定血清TNF-α、IL-2、IL4、IL-6和IL-8的浓度,记录心血管不良反应的发生情况。结果与I组比较,Ⅱ组TNF-α、IL-6及IL-8浓度降低,IL-2和IL-4浓度升高,低血压和心动过速发生率降低(P〈0.05)。两组均未发生心血管不良反应。结论采用LVETc与sV指导容量治疗能维持有效循环血容量,抑制炎性反应,适用于肝癌切除术患者。
Objective To investigate the effects of different methods of volume therapy on the inflammato- ry response in patients undergoing liver cancer resection.Methods Forty ASA I or II patients, aged 40-60 yr, with body mass index 20-25 kg/rn2 , undergoing liver cancer resection, were randomly divided into 2 groups ( n = 20 each) : routine fluid replacement group (group I ) and goal-directed fluid replacement group (group II ). The fluid replacement regime in group I = compensatory volume expansion (CVE) + physiological requirements + cumulative loss + continued loss + the third space losses. CVE was replaced with lactated Ringer's (LR) solution 5 mg/kg before anesthesia induction. The physiological requirements and cumulative loss were replaced with LR solution according to the principle of 4-2-1. The continued loss equal to the intraoperative blood loss was re- placed with the equal volume of 6% hydroxyethyl starch (HES 130/0.4). The 3rd space losses were replaced with LR solution 5 ml·kg-1·h-1 . In group II , CVE was replaced with LR sol6ution as in group I . LR solution was infused after anesthesia induction at 5ml·kg-1·h-1 1. 6 % HES was infused to maintain left ventricular ejection time (LVETc) between 350-400 ms. When 350 ms 〈 LVETc 〈 400 ms and the amplitude of stroke volume (SV) 'increased by 〉 10%, 6% HES was infused continuously until the amplitude of SV increased by ≤ 10%. Blood samples were taken before anesthesia induction and at the end of operation for measurement of serum TNF-α, IL-2,IL-4, IL-6 and IL-8 concentrations. The adverse cardiovascular reactions were recorded.Results Compared with group I , the serum TNF-a, IL-6, IL-8 concentrations were significantly decreased, the serum IL-2 and IL-4 concentrations were siguiticandy increased, and the incidence of hypotension and tachycardia was significantly decreased in group II ( P 〈 0.05). No adverse cardiovascular reactions were found in both groups. Conclusion LVETc and SV-guided volume therapy canmaintain the blood volume and inhibit the inflammatory response and is suitable for the patients undergoing liver cancer resection.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第4期477-480,共4页
Chinese Journal of Anesthesiology
基金
河北省普通高等学校强势特色学科肿瘤学建设经费资助项目
关键词
补液疗法
全身炎症反应综合征
肝切除术
Fluid therapy
Systemic inflammatory response syndrome
Hepatectomy