限制性液体治疗在肝胆外科手术中的应用

Application of Restrictive Fluid Therapy in Hepatobiliary Surgery

目的 探讨限制性液体治疗在肝胆外科手术中的应用。方法 择期行肝胆外科手术的患者40例,ASAⅠ~Ⅱ级,年龄33~72岁,随机分为开放组和限制组,开放组术中输液量=CVE（代偿性血管内容量扩张量）＋缺失量＋维持量＋丢失量＋第三间隙缺失量,限制组术中初始速度4 ml/（kg·h）,根据动态监测数据调整输液速度,记录入室（T_0）、诱导后（T_1）手术1 h后（T_2）、术毕（T_3）时的MAP、CVP和HR,术中液体总量、尿量和出血量,术后排气时间、住院时间、术后并发症等情况。结果 与开放组比较,限制组CVP在T_1、T_2差异有统计学意义（P〈0.05）,术中补液量、尿量均少（P〈0.05）,术后并发症无明显区别（P〉0.05）。结论 限制性液体治疗在肝胆外科手术中,容量治疗方案更优,血流动力学平稳、缩短了住院时间,符合加速康复外科（ERAS）的要求。

Objective To evaluate the application of restrictive fluid therapy in hepatobiliary surgery. Methods Forty patients（ASA IorII, 33-- 72 years old）undergoing hepatobiliary surgery, were included and ran- domly divided into liberal group and restrictive group. The volume dose of fluid infuse during the operation at lib- eral group = CVE ＋ human basal and Physiological reguirements ＋ addup absence ＋ continue absence ＋ the third space absence. The initial rate of 4 ml/（kg＇ h） in the restrictive group was adjusted according to the dynamic monitoring data. The variation of MAP, HR and CVP at the onset of the monitoring（T0 ）, the moment after anesthesia indction（T1）, one hour after surgery（T2） and the end of the surgery（T3）. The patients＇ clinical data wet analyzed, including volume of fluid input, urine volume, intraoperative blood loss, exhaust time, hospitaliza- tion time and complications. Results Compared with the liberal group, there were significantly in T1 and T2. The volume of fluid input, urine volume exhaust time and hospitalization time for restrictive group were signifi- cantly less/shorter than those for iberal group. There were no statistical differences in the other indexes between the two groups. Conclusion Restrictive fluid therapy in hepatobiliary surgery, better treatment capacity, stable hemodynamics, shorten the hospitalization time, meets the requirement of enhanced recovery after surgery （ERAS）.