CAJ | 학술논문

目的比较肠癌根治术病人麻醉诱导前6%羟乙基淀粉130/0.4.麻醉诱导后乳酸钠林格氏液血液稀释与麻醉诱导前乳酸钠林格氏液-麻醉诱导后6%羟乙基淀粉130/0.4血液稀释容量治疗的效果.方法拟行肠癌根治术病人40例,ASA Ⅰ或Ⅱ级,年龄45～64岁,体重42～65 kg,随机分为2组(n=20),Ⅰ组麻醉诱导前经30min静脉输注6%羟乙基淀粉130/0.4 15 ml/kg,麻醉诱导后即刻经30 min静脉输注乳酸钠林格氏液15 ml/kg;Ⅱ组于麻醉诱导前经30 min静脉输注乳酸钠林格氏液15 ml/kg,麻醉诱导后即刻经30 min静脉输注6%羟乙基淀粉130/0.4 15 ml/kg.记录术中胶体液量、晶体液量、出血量、尿量和异体输血情况;于人室后(基础状态,T0)、麻醉诱导后即刻(T1、15 min(T2)、60 min(T3)、120 min(T4)及术毕(T5)时记录平均动脉压(MAP)、中心静脉压(CVP)和心率(HR);于T0、T1、T3、T5时抽取桡动脉血样1 ml行血气分析,并测定血红蛋白浓度(Hb)和红细胞压积(Hct).结果两组均未输异体血,术中胶体液用量,晶体液用量、出血量、尿量差异无统计学意义(P>0.05);与基础值比较,Ⅰ组术中MAP、HCO-3、血浆乳酸、Na+、K+的浓度差异无统计学意义(P>0.05),CVP升高,HR、Hct、Hb降低,术毕时pH值降低,Ⅱ组术中CVP升高,MAP、HR、pH值降低,术毕时HCO-3降低(P<0.05),血浆乳酸、Na+、K+的浓度差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组术中CVP升高,术毕时血浆乳酸浓度降低(P<0.05).结论肠癌根治术病人采用麻醉诱导前6%羟乙基淀粉130/0.4-麻醉诱导后乳酸钠林格氏液血液稀释的容量治疗效果较好.
목적 비교장암근치술병인마취유도전6%간을기정분130/0.4.마취유도후유산납림격씨액혈액희석여마취유도전유산납림격씨액-마취유도후6%간을기정분130/0.4혈액희석용량치료적효과.방법 의행장암근치술병인40례,ASA Ⅰ혹Ⅱ급,년령45～64세,체중42～65 kg,수궤분위2조(n=20),Ⅰ조마취유도전경30min정맥수주6%간을기정분130/0.4 15 ml/kg,마취유도후즉각경30 min정맥수주유산납림격씨액15 ml/kg;Ⅱ조우마취유도전경30 min정맥수주유산납림격씨액15 ml/kg,마취유도후즉각경30 min정맥수주6%간을기정분130/0.4 15 ml/kg.기록술중효체액량、정체액량、출혈량、뇨량화이체수혈정황;우인실후(기출상태,T0)、마취유도후즉각(T1、15 min(T2)、60 min(T3)、120 min(T4)급술필(T5)시기록평균동맥압(MAP)、중심정맥압(CVP)화심솔(HR);우T0、T1、T3、T5시추취뇨동맥혈양1 ml행혈기분석,병측정혈홍단백농도(Hb)화홍세포압적(Hct).결과 량조균미수이체혈,술중효체액용량,정체액용량、출혈량、뇨량차이무통계학의의(P>0.05);여기출치비교,Ⅰ조술중MAP、HCO-3、혈장유산、Na+、K+적농도차이무통계학의의(P>0.05),CVP승고,HR、Hct、Hb강저,술필시pH치강저,Ⅱ조술중CVP승고,MAP、HR、pH치강저,술필시HCO-3강저(P<0.05),혈장유산、Na+、K+적농도차이무통계학의의(P>0.05);여Ⅰ조비교,Ⅱ조술중CVP승고,술필시혈장유산농도강저(P<0.05).결론 장암근치술병인채용마취유도전6%간을기정분130/0.4-마취유도후유산납림격씨액혈액희석적용량치료효과교호.
Objective To compare the efficacy of two regimens of volume therapy in patients undergoing radical intestinal cancer operation. Methods Forty ASA Ⅰ or Ⅱ patients, aged 45-64 yr, weighing 42-65 kg,scheduled for radical intestinal cancer operation, were randomly divided into group Ⅰ and group Ⅱ (n = 20 each).In group Ⅰ , 6% hydroxyethyl starch 130/0.4 (HES) 15 ml/kg was infused iv over 30 min before anesthesia induction, and lactated Ringer's solution 15 ml/kg was infused iv over 30 min immediately after anesthesiainduction for hemodilution. In group Ⅱ , lactated Ringer's solution 15 ml/kg was infused iv over 30 min before anesthesia induction, and HES 15 ml/kg was infused iv over 30 min immediately after anesthesia induction for hemodilution. Intraoperative infusion of colloid and crystalloid, blood loss, urine output and allngeneic blood transfusion were recorded. MAP, CVP and HR were recorded after entering the operating room (T0 , baseline),and at 0, 15, 60 and 120 min after anesthesia induction (T<1-4>), and at the end of operation (T5). Blood samples were taken from radial artery at To , T0 , T3 and T5 for blood gas analysis and determination of Hb and Hct. Results Allogeneic blood was not transfused in beth groups. There were no significant differences in infusion of colloid and erystalloid, blood loss, and urine output between the two groups (P>0.05). Compared with the baseline value, no were significant changes in intraoperative MAP, HCO-3, concentrations of lactate, Na+ and K+ were detected (P> 0.05), while CVP was significantly increased, and HR, Het, Hb, and pH value at the end of operation were significantly decreased in group Ⅰ . Compared with the baseline value, intraoperative CVP was significantly increased, and MAP, HR, pH value, and HCO-3 at the end of operation were significantly decreased,while no significant changes in concentration lactate, Na+ and K+ were detected in group Ⅱ (P > 0.05).Intraoperative CVP was significantly higher and lactate concentration at the end of operation significantly lower in group Ⅱ than in group Ⅰ . Conclusion The efficacy of volume therapy with HES before anesthesia induction and lactated Ringer's solution after anesthesia induction for hemodilution is better.