区域性胰腺切除术围手术期的液体治疗

Perioperative fluid treatment of regional pancreatectomy

目的 探讨区域性胰腺切除术围手术期液体的正、负平衡及治疗特点。方法 2 0 0 0～ 2 0 0 2年 ,对 16 5例病人采用术前水化使血液轻度稀释 ,术日和术后第 1天以红细胞压积 (HCT)、中心静脉压 (CVP)和尿量为指标 ,等量补充血液 ,足量输入平衡液 ,不用血管加压药 ,术后第 2～ 3天慎用小剂量利尿剂 ,注意负平衡的出现。结果 平均每例术日输液 (84 89.0 1± 174 3.17)mL ,术后第 1天输液 (4 372 .2 7± 96 7.18)mL。尿量从术后第 1～ 3天逐渐增加。术日和术后第 1天正平衡量分别为 (2 5 6 2 .73± 786 .99)mL和 (14 15 .98± 5 79.11)mL。术后第 2天 10 7例出现负平衡 ,第 3天 14 7例 ,负平衡量达 (14 90 .84± 2 97.4 3)mL。未出现负平衡者中 ,12例发生与液体治疗无关的严重并发症 ,2例死亡。结论 该方案完全适于区域性胰腺切除术围手术期的液体治疗 ,术后第 2～ 3天出现液体负平衡 ,否则预示发生严重并发症的可能。

Objective To investigate the positive fluid balance and negative fluid balance and characteristics of perioperative fluid treatment of the regional pancreatectomy. Methods From 2000 to 2002,for 165 cases of the regional pancreatectomy, the slight dilution of blood was achieved by intromission of equilibrium liquid. On the operative day and the first postoperative day, based on CVP、HCT and urine output, blood was supplemented equivalently and equilibrium liquid was infused sufficiently, without using any angiotension. On the 2nd or 3rd postoperative day, micro-dose of diuretic was applied and the occurrence of negative fluid balance was monitored. Results On the operative day and the first postoperative day, average volume of infusion was (8489.01±1743.17)mL and (4372.27±967.18)mL respectively. Average urine output increased step by step from the first postoperative day to the 3rd postoperative day. The volume of positive fluid balance on the operative day and the first postoperative day was(2562.73±786.99)mL and(1415.98±579.11)mL respectively. On the 2nd postoperative day, the negative fluid balance occurred in 107 cases, and 147 cases on the 3rd postoperative day,the average volume of the negative fluid balance being(1490.84±297.43)mL.Meantime, in the rest 18 cases, severe complication irrelated to liquid emerged in 12 cases, including 2 death cases. Conclusion The protocol is suitable for perioperative fluid treatment of the regional pancreatectomy, and the negative fluid balance is to be expected on the 2nd or 3rd postoperative day, otherwise complication will be likely to take place.