开放性输液对肠梗阻手术患者术中生命体征的影响

To study the effect of the liberal fluid on vital signs of patients undergoing ileus surgery

目的探讨开放性输液对肠梗阻手术患者术中生命体征的影响。方法将本院2013年1月一2014年9月期间在静．吸复合全身麻醉下行肠梗阻手术的患者60例，采用随机数字表法将其分为两组，每组30例：常规量输液组（N组）和开放性输液组（L组）。输液量：诱导前N组和L组患者分别输入4ml／kg和15ml／kg乳酸钠林格液，术中两组患者分别输入15ml·kg^-1·h^-1和40m·kg^-1·h^-1至缝皮结束。出血患者根据出血量及血红蛋白含量，选择性输入羟乙基淀粉130／0．4氯化钠注射液或浓缩红细胞悬液和新鲜冰冻血浆。分别于患者入室时、肠梗阻解除时、关腹时监测患者心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）、中心静脉压（central venous pressure，CVP）、尿量（urine volume，uv）。结果L组较N组HR[（81±5）次／rain比（102±12）次／rain]、MAP[（98±10）mmHg比（77±8）mmHg（1mmHg=0．133kPa）]、CVP[（9．5±0．7）cmH20比（6．5±0．5）cmH2O（1cmH2O=0．098kPa）]等患者生命体征的波动明显降低（P〈0．05），L组uV也显著高于N组[（320±50）ml比（90±20）m1]（P〈0．05）；N组中有7例患者需用升压药麻黄素来维持血压的平稳。结论对于肠梗阻患者，手术中施行开放性输液治疗有助于维持患者生命体征的乎稳，并能保证患者重要器官与组织的充分血液灌注，更有利于保证患者手术期间的生命安全。

Objective To study the effect of the liberal fluid on vital signs of patients undergoing ileus surgery. Methods Sixty patients undergoing the ileus surgery with intravenous-inhalation anesthesia from January 2013 to September 2014, were randomly divided into two groups by the random number table method （n=30）： group N with normal fluid and group L with liberal fluid. Fluid volume： before anesthesia, group N was infused with sodium lactate ringer＇s solution 4 ml/kg and group L with sodium lactate ringer＇s solution 15 ml/kg. During the surgery, group N was infused with 15 ml·kg-1·h-1 and group L with 40 ml·kg-1 ·h-1 until the completion of suture of skin. Haemorrhage patients, depending on blood volume and hemoglobin level, were infused with hydroxyethyl separately, or with concentrated red blood cell suspension and fresh freezing plasma collectively. Heart rate（HR）, mean arterial pressure （MAP）, central venous pressure （CVP）, urine volume （UV） were monitored at the time points of entrance, ileus relieving and suture of abdominal. Results The per minute vital signs HR[（81±5） bpm vs （102±12） bpm], MAP[（98±10） mmHg vs （77±8） mmHg（1 mmHg=0.133 kPa）], CVP[（9.5±0.7） cmH20 vs （6.5±0.5） cmH2O （1 cmH2O=0.098 kPa）] （P〈0.05） were obviously less fluctuated in group L than that in group N, wheras the urine volume [（320±50） ml vs （90±20） ml ] （P〈0.05） was more in group L than in group N. In addition, there were seven cases in group N used normal fluid requiring ephedrine in order to maintain blood pressure. Conclusions For ileus surgery patients, using liberal fluid may help keeping the vital signs stable, providing a sufficient blood perfusion in the key organs and tissues and ensuring patients safty during operation.