目标导向液体治疗对脑肿瘤切除术的效果评价

Analysis on Application Effect of Goal-directed Fluid Therapy in Brain Tumor Resection

目的:探讨目标导向液体治疗(GDFT)在脑肿瘤切除术中的应用效果及对患者术后认知功能、脑代谢的影响。方法:选取80例行脑肿瘤切除术的患者,依据患者术中输液方式不同分为GDFT组和对照组,各40例。对照组予以常规输液治疗,GDFT组予以目标导向液体治疗,比较2组术中补液情况、手术恢复相关指标(重症监护病房停留时间、术后住院时间、并发症]、脑代谢指标[动脉血氧含量(CaO2)、颈内静脉球血氧含量(CjvO2)、桡动脉-颈内静脉球部血氧含量差(Ca-jvO2)]、简易智力状态量表(MMSE)评分、神经功能评定量表(NHISS)评分。结果:GDFT组晶体量[(312.56±95.41)m L]及总入超量[(1123.56±524.41)m L]少于对照组(P<0.05);GDFT组重症监护病房停留时间、术后住院时间均短于对照组(P<0.05),GDFT组并发症发生率(5.00%)与对照组(10.00%)比较,差异无统计学意义(P>0.05);T1~T4时刻,GDFT组CaO2、Ca-jvO2均高于对照组(P<0.05),CjvO2均低于对照组(P<0.05);术后,GDFT组MMSE评分[(27.99±2.65)分]高于对照组[(25.03±1.56)分](P<0.05),NHISS评分[(15.36±4.26)分]低于对照组[(19.37±5.04)分](P<0.05)。结论:目标导向液体治疗应用于脑肿瘤切除术,能够改善患者的脑代谢状态,改善神经及认知功能损伤。

Objective:To explore the application effect of goal-directed fluid therapy(GDFT)on brain tumor resection and its influences on postoperative cognition function and brain metabolism.Methods:80 patients undergoing brain tumor resection.They were divided into GDFT group(40 cases)and routine group(40 cases)according to different intraoperative transfusion methods.The routine group was given routine transfusion treatment,while GDFT group was given GDFT.The intraoperative fluid infusion,surgical recovery related indexes[staying time in intensive care unit(ICU),postoperative hospitalization time,complications],cerebral metabolism[arterial blood oxygen content(CaO2),jugular bulb oxygen content(CjvO2),cerebral arterial-jugular venous oxygen content difference(Ca-jvO2)],cognitive function[mini-mental state examination(MMSE)],and nerve function[National Institute of Health Stroke Scale(NHISS)]were compared between the two groups.Results:The crystal volume and total fluid infusion volume in GDFT group were significantly less than those in routine group(P<0.05).The staying time in ICU and postoperative hospitalization time in GDFT group were significantly shorter than those in routine group(P<0.05).There was no significant difference in incidence of complications between GDFT group and routine group(5.00%vs 10.00%)(P>0.05).At T1-T4,CaO2 and Ca-jvO2 in GDFT group were significantly higher than those in routine group(P<0.05),while CjvO2 was significantly lower than that in routine group(P<0.05).After surgery,MMSE score of GDFT group was significantly higher than that of routine group(P<0.05),while NHISS score was significantly lower than that of routine group(P<0.05).Conclusion:The application of GDFT in brain tumor resection during perioperative period can improve cerebral metabolism status of patients,and avoid injury of nerve and cognition function.