限制性输液在妇科腹腔镜手术中的初步应用

A Preliminary Clinical Study of Restrictive Transfusion Administration on Gynecological Laparoscopic Surgery

目的:评估限制性输液在妇科腹腔镜术中运用的可行性及安全性。方法:选择32例妇科腹腔镜子宫全切术患者,ASA分级I～II级,术前心、肺、脑、肾等重要脏器功能正常。随机分为A和B组,A组为限制性输液组,液体量15ml/Kg。B组为非限制性输液组,40ml/Kg。分别于麻醉前(T0)、气腹前即刻(T1)、气腹后5分钟(T2)、气腹后10分钟(T3)、气腹后20分钟(T4)、气腹后30分钟(T5),气腹结束后5分钟(T6),10分钟(T7)记录中心静脉压,平均动脉压,心率,心输出量,每搏量变异度,每搏量。于麻醉前(T0)和术毕时(T7)抽取桡动脉血做血气分析,记录血气指标:乳酸,血红蛋白浓度,红细胞压积。术后第一天采血查乳酸,血红蛋白浓度,红细胞压积。结果:各循环指标,两组相比差异无统计学意义(P>0.05),两组的变化趋势是一致的。T0时两组血气指标差异无统计学意义(P>0.05),T7时两组乳酸差异无统计学意义(P>0.05)。T7时,与B组相比,A组的Hb和HCT增加(P<0.05)。A组术后PACU停留时间及住院时间缩短(P<0.05)。结论:妇科腹腔镜手术中,限制性输液可维持患者循环动力学稳定,保证组织氧合,减轻球结膜水肿,缩短术后苏醒时间及住院时间。限制性输液可运用于妇科腹腔镜手术中,有一定的临床意义。

Objective：To evaluate the effect of pneumoperitoneum in the steep Trendelenbure position on cardiovascular system with arterial pressure waveform analysis.Methods：Thirty-two patients of American Society of Anesthesiologist（ASA）I and II physical status,undergoing laparoscopic radical resection of uterus and the preoperative state of critical organ including heart,lung,encephalon and kidney was normal.Patients were randomly allocated into two groups,Group A and B.The patients in Group A received restrictive fluid,15ml/Kg.The ones in Group B received liberal fluid,40ml/Kg.Their Heart Rate,Central Venous Pressure,Cardiac Output,Mean Arterial Blood Pressure and Stroke Volume were monitored respectively before-anesthesia（T0） before the pneumoperitoneum（T1）,5min（T2）,10min（T3）,20min（T4）30min（T5）after the pneumoperitoneum and 5 min（T6）,10 min（T7） after the deflation of abdomen.Before anesthesia（T0） and at the end of the operation（T7） extraction arterial blood for blood gas analysis,recording blood gas indexes：Lactic acid,hemoglobin and hematocrit.After the first day of operation,recording blood gas indexes：Lactic acid,hemoglobin and hematocrit.Results：There was no significant difference in the cycle index（P0.05） between the two groups,but they have the same trend.There was no significant difference in blood gas indexs at T0 between the two groups（P0.05）.There was no significant difference in Lac at T7 between the two groups（P0.05）.Compared with group B,the Hb and HCT in group A were increased（P0.05）.PACU residence time and hospitalization time were decreased in group A（P0.05）.Conclusion：Laparoscopic gynecologic operation,restrictive transfusion can maintain hemodynamic stability,ensure the tissue oxygenation,reduce conjunctival edema,shorten the recovery time and hospital stay time.Restrictive transfusion can be used in gynecological laparoscopic operation.