脑胶质瘤切除术中目标导向液体对患者的脑保护作用

The Cerebral Protection Investigation of Goal-directed Fluid Therapy in Brain Glioma Resection

目的探讨脑胶质瘤切除术中目标导向液体对患者的脑保护作用。方法选择67例脑胶质瘤患者,根据入院先后顺序,分为观察组(32例)及对照组(35例)。观察组给予目标导向液体补液,对照组给予常规补液。观察两组手术时间、监护病房停留时间及住院天数;两组晶体液用量、胶体液用量、总输液量、尿量、出血量及血管活性药物使用情况;两组T1~T5时的CI,两组术后12 h及24 h的NIHSS评分及术前及出院时的MMSE评分。结果两组手术时间、监护病房停留时间及住院天数对比,差异均无统计学意义,P>0.05;观察组的胶体液用量、总输液量、尿量明显高于对照组;两组T5时CI明显高于T1,观察组T5时CI明显高于对照组;两组术后24 h NIHSS评分均较术后12 h明显降低,且观察组明显低于对照组;两组出院时MMSE较术前均明显升高,且观察组明显高于对照组,P均<0.05。结论目标液体导向补液可以提高脑胶质瘤患者围术期胶体液用量、总输液量、尿量及术后24 h的CI值,提高患者术后24 h的NIHSS评分及出院时的MMSE评分,有利于保护脑组织。

Objective To investigate the cerebral protection of goal-directed fluid therapy in brain glioma resection.Methods 67 cases with brain glioma resection were chosen and divided into the observation group（ 32 cases） and the control group（ 35 cases）. The observation group were given goal-directed fluid therapy,the control group were given conventional fluid replacement. The operation time,monitor ward stay time and stay length of the 2 groups were compared,the crystal liquid dosage,gel volume,total infusion quantity,urine volume,bleeding amount,vasoactive agent usage condition of the 2 groups were compared,the CI of two groups at T1-T5,the NIHSS score of the 2 groups after surgery for 12 and 24 h,the MMSE score of the 2 groups before surgery and discharge were compared. Results The operation time,monitor ward stay time and stay length of the 2 groups had no significant difference,P 〉 0. 05. The crystal liquid dosage,total infusion quantity and urine volume of the observation group were higher than the control group,the CI of the 2 groups at T5 were higher than T1,the CI at T5 of the observation group was higher than the control group,the NIHSS score of the 2 groups after surgery for 24 h were lower than after surgery for 12 h,the observation group was lower than the control group. The MMSE score of the 2 groups at discharge were higher than before surgery,and the observation group was higher than the control group,P 〈 0. 05. Conclusion Goal-directed fluid therapy could improve the crystal liquid dosage,total infusion quantity,urine volume and CI after surgery for 24 h in patients with brain glioma resection,and improve the NIHSS score after surgery for 24 h and MMSE score at discharger,which is helpful to protect brain tissue.