高龄胃癌患者胃癌根治术后液体治疗的优化临床观察

Study on optimization of fluid therapy in elderly patients with gastric cancer after radical gastrectomy

[目的]探讨高龄胃癌患者胃癌根治术后液体治疗的合理优化方案.[方法]将老年胃癌患者分为治疗组及对照组,两组均行标准D2手术,治疗组术后第1,2,3d加用60g/L羟乙基淀粉130/0.4氯化纳注射液(60g/L HES)20mL/(kg·d),对照组术后给予等量液体(葡萄糖氯化钠注射液),其余治疗均相同.观察两组患者术后1,2,3d液体量,心率、中心静脉压及平均动脉搏压的变化;比较自主排气恢复时间、进全流食时间及平均住院时间.[结果]治疗组自主排气恢复时间为(2.8±1.4)d,对照组为(3.5±1.5)d,相比较差异具有统计学意义(P<0.05);治疗组术后进全流食时间及平均住院时间均明显短于对照组(P<0.05).[结论]60g/L羟乙基淀粉130/0.4氯化纳注射液补液优于单纯晶体补液,为今后高龄胃癌患者D2术后液体正确输入提供了优化的补液方案.

OBJECTIVE To investigate reasonable optimization scheme of liquid treatment in elderly patients with gastric cancer after radical gastrectomy. METHODS Elderly patients with gastric cancer were divided into treatment and control groups, and were underwent with the standard D2 operation. At 1, 2, 3 days after operation, the treatment group was treated with 60 g/L hydroxyethyl starch 130/0.4 sodium chloride （60 g/L HES） 20 mL/（kg d）, and the control group with an equal amount of liquid （glucose and sodium chloride）, and other treatments were the same, and the liquid volume, heart rate, central venous pressure, the changes of mean arterial pulse pressure were observed in two groups, and the independent exhaust recovery time, all flow time and average hospitalization time were compared. RESULTS Independent exhaust recovery time in treatment and control groups was （2.8 ± 1.4） days and （3.5 ± 1.5） days, respectively, and there was a significant difference between two groups （P 〈 O. 05）, and postoperative eating liquid food and average hospitalization time were significantly shorter in treatment group than in control group （P〈0.05）. CONCLUSION The 60 g/L hydroxyethyl starch 130/0.4 sodium chloride injection liquid is superior to single crystal rehydration that provides fluid optimization scheme for elderly patients with gastric cancer after the standard D2 operation in correct fluid input in clinic