CAJ | 학술논문

目的评价每搏变异度指导术中限制性输液对肝叶切除术病人肝肾功能的影响.方法择期开腹下行肝叶切除术病人40例,年龄33～60岁,ASA分级Ⅰ～Ⅲ级,性别不限,采用随机数字表法,将病人随机分为2组(n=20):常规输液组(A组)和限制性输液组(B组).麻醉诱导:静脉注射利多卡因、芬太尼和顺阿曲库铵,靶控输注异丙酚.气管插管后行机械通气,麻醉维持:吸入七氟醚,间断追加芬太尼和顺阿曲库铵,维持BIS值40～60.术中静脉输注复方电解质注射液和6%羟乙基淀粉130/0.4,晶体液和胶体液的比例为2∶1,A组和B组输液速率分别为10～20和5～12 ml·kg-1·h-1,分别维持每搏变异度值5～7和11～13.术中监测血液动力学指标.记录术中异体输血情况、出血量和尿量.分别于术前(基础状态)、术后1、3、5 d时采集静脉血样,测定血清ALT、AST、总蛋白(TP)、白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、尿素氮、肌酐和乳酸的水平;同时测定Hb和Hct.结果 2组术中血液动力指标均在正常范围内.与A组比较,B组异体输血率降低,输血量、出血量和尿量减少,术后1 d时血清TP和ALB的浓度升高(P＜0.05).与基础值比较,2组术后血清ALT、AST、TBIL和DBIL的水平升高,血清TP、ALB的浓度、Hb和Hct降低(P＜0.05),其它指标差异无统计学意义(P＞0.05).结论每搏变异度值能够有效地指导肝叶切除术病人限制性输液.
목적 평개매박변이도지도술중한제성수액대간협절제술병인간신공능적영향.방법 택기개복하행간협절제술병인40례,년령33～60세,ASA분급Ⅰ～Ⅲ급,성별불한,채용수궤수자표법,장병인수궤분위2조(n=20):상규수액조(A조)화한제성수액조(B조).마취유도:정맥주사리다잡인、분태니화순아곡고안,파공수주이병분.기관삽관후행궤계통기,마취유지:흡입칠불미,간단추가분태니화순아곡고안,유지BIS치40～60.술중정맥수주복방전해질주사액화6%간을기정분130/0.4,정체액화효체액적비례위2∶1,A조화B조수액속솔분별위10～20화5～12 ml·kg-1·h-1,분별유지매박변이도치5～7화11～13.술중감측혈액동역학지표.기록술중이체수혈정황、출혈량화뇨량.분별우술전(기출상태)、술후1、3、5 d시채집정맥혈양,측정혈청ALT、AST、총단백(TP)、백단백(ALB)、총담홍소(TBIL)、직접담홍소(DBIL)、뇨소담、기항화유산적수평;동시측정Hb화Hct.결과 2조술중혈액동력지표균재정상범위내.여A조비교,B조이체수혈솔강저,수혈량、출혈량화뇨량감소,술후1 d시혈청TP화ALB적농도승고(P＜0.05).여기출치비교,2조술후혈청ALT、AST、TBIL화DBIL적수평승고,혈청TP、ALB적농도、Hb화Hct강저(P＜0.05),기타지표차이무통계학의의(P＞0.05).결론 매박변이도치능구유효지지도간협절제술병인한제성수액.
Objective To investigate the effect of stroke volume variability (SVV)-guided intraoperative fluid restriction on liver and renal function in patients undergoing hepatic lobectomy. Methods Forty ASA Ⅰ - Ⅲpatients of both sexes aged 33-60 yr weighing 52-80 kg undergoing elective hepatic lobectomy were randomly divided into 2 groups ( n = 20 each): group A routine fluid administration and group B restricted fluid administration.Anesthesia was induced with iv lidocaine, fentanyl and TCI of propofol (target plasma concentration 3-4 μg/ml).Tracheal intubation was facilitated with cisatracurium 0.2 mg/kg. The patients were mechanically ventilated.PETCO2 was maintained at 32-38 mm Hg. Anesthesia was maintained with 1%-2% sevoflurane inhalation and intermittent iv boluses of fentanyl and cisatracurium. BIS value was maintained at 40-60. Radial artery was cannulated and connected to continuous cardiac output monitor (Edwards Lifeaciences, USA). ECG, MAP, CVP and SVVtained at 5-7 in group A and 11-13 in group B. Blood loss, urine output and the amount of RBC and plasma infused during operation were recorded. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (TP), albumin (ALB), total bilirubin ( TBIL), direct bilirubin ( DBIL), blood urea nitrogen (BUN), creatinine (Cr) and lactate and Hb, Hct were measured the day before surgery (baseline) and at day 1,3 and 5 after operation. Results The hemodynamic parameters were maintained within normal limits during operation in both groups. The blood loss, the amount of RBC and plasma infused and urine output during operation were significantly less, while the serum TP and ALB concentrations were higher on the 1st postoperative day in group B than in group A. The serum levels of ALT, AST, TBIL and DBIL were significantly increased and serum concentrations of TP and ALB and Hb,Hct decreased, but there was no significant change in serum BUN and Cr concentrations and lactate after operation as compared with the baseline values before operation in both groups. There were no significant differences in serum levels of ALT, AST, TBIL, DBIL, BUN, Cr, lactate,Hb and Hct after operation between the 2 groups. Conclusion SVV can guide effectively intraoperative fluid restriction in patients undergoing hepatic lobectomy.