压力记录分析法指导儿童颅脑肿瘤切除术液体治疗的临床观察

Application of pressure recording analytical method for fluid therapy in pediatric intracranial tumor resection patients

目的探讨压力记录分析法(PRAM)指导儿童颅脑肿瘤切除术中液体治疗的应用。方法选取择期行颅脑肿瘤切除术的患儿,随机分为两组,试验组以PRAM技术获得的血流动力学参数作为液体治疗的指导,对照组依据"4-2-1"法则补液。试验组分别记录Mostcare监测仪(核心技术为PRAM)所采集的麻醉诱导时(T1)、开放硬脑膜后(T2)、肿瘤切除后(T3)、关颅时(T4)的平均动脉血压(MAP)、心率(HR)、心输出量(CO)、心脏指数(CI)、每搏量(SV)、脉压变异度(PPV)、心脏循环效率(CCE)、最大压力梯度(dp/dt)以及患儿术中补液量、尿量、失血量,随访术后ICU停留时间。对照组记录患儿MAP、HR、术中补液量、尿量、失血量,随访ICU停留时间。结果共纳入24例患儿,每组12例。两组患儿年龄、BMI、麻醉时间的差异无统计学意义(P>0.05)。试验组与对照组比较,补液量[(999±584)ml vs.(1 831±735)ml]、晶体输注量[(634.3±331.3)ml vs.(1 392.7±576.6)ml]、ICU停留时间[(1.08±0.42)d vs.(2.03±1.23)d]显著降低(P<0.05)。试验组各时间点血流动力学指标较对照组更稳定。结论 PRAM技术适用于指导小儿颅脑肿瘤切除术的液体治疗,能有效控制液体输注量,维持稳定的血流动力学状态,减少ICU停留时间。

Objective To investigate the application of pressure recording analytical method（PRAM） in pediatric intracranial tumor resection. Methods A total of 24 pediatric patients who suffered from intracranial tumor were enrolled into the study. They were divided into two groups（group P and group C）randomly. The group P used Mostcare to record four times＇ mean arterial pressure（MAP）, HR, cardiac output（CO）, cardiac index（CI）,stroke volume（SV）, pulse pressure variation（PPV）,cardiac cycle efficiency, maximum pressure gradient （T1 for anesthesia induction,T2 for after opening dural,T3 for after tumor resection ,and T4 for after closing the dural）. For the group C,MAP, HR were recorded, and total fluid volume, urine, bleeding and ICU stay time were also recorded in both groups. Results There were no significant difference in age, BMI, duration of anesthesia between the two groups. But there was significant difference in the fluid volume[（999±584）ml vs,（1831±735）ml], especially crystals[（634.3±331.3）ml vs.（ 1 392.7±576.6）ml] and ICU stay time[（1.08±0.42）d vs.（2.03±1.23）d] between the two groups （P〈0.05）.The hemodynamic parameters of the group P also kept stable. Conclusion PRAM technology is applicable for pediatric intracranial tumor resection, it can effectively guide fluid therapy, reduce the time of ICU stay.