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目标导向性液体治疗对围术期高凝患者凝血功能的影响 被引量:9
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作者 赵若光 陈彦青 +3 位作者 邹聪华 林莹 缪丽艳 龚赞辉 《福建医科大学学报》 北大核心 2016年第6期411-414,共4页
目的探讨目标导向性液体治疗(GDFT)与传统输液治疗对围术期血液高凝患者凝血功能的影响。方法选择ASAⅠ-Ⅲ级需行胃肠道肿瘤手术且入手术室后(输液前)第1次血栓弹力图结果为高凝(CI〉3)的中老年患者60例,随机分为2组(n=30),Ⅰ... 目的探讨目标导向性液体治疗(GDFT)与传统输液治疗对围术期血液高凝患者凝血功能的影响。方法选择ASAⅠ-Ⅲ级需行胃肠道肿瘤手术且入手术室后(输液前)第1次血栓弹力图结果为高凝(CI〉3)的中老年患者60例,随机分为2组(n=30),Ⅰ组采用中心静脉压(CVP)指导围术期输液即为CVP组,Ⅱ组采用每搏变异度(SVV)指导围术期输液即SVV组。CVP组根据CVP指导输液,维持CVP在9-15mmHg(1.2-2kPa);Ⅱ组采用SVV指导围术期输液,维持SVV〈10%;记录2组患者输液前(T0)、麻醉开始后3h(T2)、手术后24h(T3)血栓弹力图的凝血情况,包括反应时间(R)、凝固时间(K)、angle、血栓形成的最大幅度(MA)、综合凝血指数(CI),低凝发生率;记录2组患者输液前(T0)、麻醉诱导后即刻(T1)、麻醉诱导后3h(T2)的平均动脉压(MAP)、心率(HR)、手术时间、麻醉时间、麻醉诱导后3h的总输液量、总出血量、尿量、血管活性药使用情况、手术后至手术后24h的总出血量、术后大出血的发生率、术后7d内血栓性事件的发生率。结果与Ⅰ组比较,Ⅱ组患者T0血栓弹力图结果无明显差别(P〉0.05);2组患者T2,T3时的凝血因子功能和纤维蛋白原功能明显减弱(P〈0.05),而血小板功能和综合凝血功能无差别(P〉0.05)。与Ⅰ组比较,Ⅱ组T2时的凝血因子功能较强(P〈0.05);综合凝血功能较强(P〈0.05);低凝的发生率明显减少,差别有统计学意义(P〈0.05);T3的R,K,angle及MA差别无统计学意义(P〉0.05);T0,T1及T2的MAP,HR,麻醉诱导后3h内的总出血量及血管活性药使用量差别无统计学意义(P〉0.05);麻醉诱导后3h内的总输液量、尿量明显减少,差别有统计学意义(P〈0.05);手术结束后24h的总出血量差别无统计学意义(P〉0.05)。2组患者术后7d内均无血栓事件发生。结论 GDFT与传统输液治疗比较,可较好的纠正围术期血液高凝患者的凝血状态。 展开更多
关键词 *补液疗法 手术期间 *围手术期护理 *血凝固障碍 凝固
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Individualized peri-operative fluid therapy facilitating early-phase recovery after liver transplantation 被引量:6
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作者 Guo-Qing Jiang Ping Chen +3 位作者 Dou-Sheng Bai Jing-Wang Tan Hao Su Min-Hao Peng 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第16期1981-1986,共6页
AIM:To investigate the correlation between peri-operative fluid therapy and early-phase recovery after liver transplantation(LT) by retrospectively reviewing 102 consecutive recipients.METHODS:Based on whether or not ... AIM:To investigate the correlation between peri-operative fluid therapy and early-phase recovery after liver transplantation(LT) by retrospectively reviewing 102 consecutive recipients.METHODS:Based on whether or not the patients had pulmonary complications,the patients were categorized into non-pulmonary and pulmonary groups.Twentyeight peri-operative variables were analyzed in both groups to screen for the factors related to the occurrence of early pulmonary complications.RESULTS:The starting hemoglobin(Hb) value,an intra-operative transfusion > 100 mL/kg,and a fluid balance ≤-14 mL/kg on the first day and the second or third day post-operatively were significant factors for early pulmonary complications.The extubation time,time to initial passage of flatus,or intensive care unit length of stay were significantly prolonged in patients who had not received an intra-operative transfusion ≤ 100 mL/kg or a fluid balance ≤-14 mL/kg on the first day and the second or the third day post-operatively.Moreover,these patients had poorer results in arterial blood gas analysis.CONCLUSION:It is important to offer a precise and individualized fluid therapy during the peri-operative period to the patients undergoing LT for cirrhosis-associated hepatocellular carcinoma. 展开更多
关键词 Fluid therapy Liver transplantation Earlyphase recovery Pulmonary complications HEMOGLOBIN
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