麻醉期间目标导向液体治疗对胶质瘤开颅切除术患者预后的影响

Influence of goal-directed fluid therapy during anesthesia on prognosis of patients with craniotomy of glioma

目的探讨麻醉期间目标导向液体治疗（GDT）对胶质瘤开颅切除术患者预后的影响。方法选取本院2013年5月-2014年5月收治的80例行胶质瘤开颅切除术患者作为研究对象,按照随机数字表法分为研究组和对照组,各40例。研究组麻醉期间采用GDT,对照组采用常规输液治疗。比较两组不同时间点的一般血流动力学指标、住院时间、神经功能缺损评分及手术前后的KPS评分。结果研究组T_3时刻的Scv O_2、CVP水平显著高于T1时刻和对照组,差异有统计学意义（P〈0.05）。两组T_2、T_3时刻的MAP水平显著低于T1时刻,差异有统计学意义（P〈0.05）。研究组T_2、T_3时刻的MAP水平显著高于对照组,差异有统计学意义（P〈0.05）。研究组T_2及T_3时刻的rSO_2水平显著高于T1时刻和对照组,差异有统计学意义（P〈0.05）。研究组的住院时间显著短与对照组,24 h神经功能缺损评分显著低于对照组,差异有统计学意义（P〈0.05）。两组出院前的KPS评分显著高于术前1 d,差异有统计学意义（P〈0.05）。研究组出院前的KPS评分显著高于对照组出院前,差异有统计学意义（P〈0.05）。结论胶质瘤开颅切除术患者麻醉期间使用GDT可维持有效血容量,保证脑供氧及适当灌注状态,能够明显缩短住院时间,值得临床推广应用。

Objective To explore the influence of goal-directed fluid therapy during anesthesia on prognosis of patients with craniotomy of glioma. Methods 80 cases with glioma craniotomy from May 2013 to May 2014 in our hospital were selected and randomly divided into the control group and the study group,40 cases in each group.The study group was given goal-directed fluid therapy during anesthesia,the control group was given conventional infusion therap.The index of general hemodynamics at different time points,hospitalization time,neurological function defect score and KPS score before and after operation in two groups was compared. Results The level of Scv O_2,CVP in the study group at T_3 were higher than that at T_1 and in the control group,with significant difference（P〈0.05）.The level of MAP in two groups at T_2,T_3 was lower than that at T_1,with significant difference（P〈0.05）.The level of MAP in the study group at T_2,T_3 was lower than that in the control group,with significant difference（P〈0.05）.The level of r SO_2 in the study group at T_2,T_3 was lower than that at T_1 and in the control group,with significant difference（P〈0.05）.The hospitalization time in the study group was shorter than that in the control group,the score of 24 h neural function defect in the study group was lower than that in the control group,with significant difference（P〈0.05）.The KPS score of two groups before hospital discharge was higher than that before surgery at 1 day,with significant difference（P〈0.05）.The KPS score of the study group before hospital discharge was higher than that in the control group before hospital discharge,with significant difference（P〈0.05）. Conclusion The use of GDT during anesthesia for patients with craniotomy of glioma can maintain effective blood volume,ensure cerebral oxygen supply and proper perfusion,which can significantly shorten the time of hospitalization,it is worthy of clinical promotion and application.