CAJ | 학술논문

目的评价不同容量治疗方法对肝癌切除术患者炎性反应的影响.方法择期行肝癌切除术患者40例,性别不限,年龄40～60岁,体重指数20～25 kg/m,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其随机分为2组(n=20):常规补液组(Ⅰ组)和目标管理补液组(Ⅱ组).Ⅰ组补液量为补偿性扩容量+生理需要量+累计缺失量+继续损失量+第三间隙丢失量,补偿性扩容量于麻醉诱导前以乳酸钠林格氏液补充,补液量为5ml/kg,继续损失量按失血量计算,以HES 130/0.4等量补充,第三间隙丢失量采用乳酸钠林格式液以5ml·kg·-1·h-1补充,生理需要量与累计缺失量根据4-2-1法则以乳酸钠林格式液补充.Ⅱ组补偿性扩容置于麻醉诱导前补充,方法同Ⅰ组,麻醉诱导后静脉输注乳酸钠林格氏液5 ml·kg-1·h-1,同时根据每搏量(SV)和校正左室射血时间(LVETc)指导补液,维持LVETc 350～400 ms;350 ms＜ LVETc＜ 400 ms,且SV增加幅度＞10％时,则继续静脉输注6％ HES 130/0.4,直至SV增幅≤10％.于麻醉诱导前和术毕时取静脉血样,测定血清TNF-α、IL-2、IL-4、IL-6和IL-8的浓度,记录心血管不良反应的发生情况.结果与Ⅰ组比较,Ⅱ组TNF-α、IL-6及IL-8浓度降低,IL-2和IL-4浓度升高,低血压和心动过速发生率降低(P＜0.05).两组均未发生心血管不良反应.结论采用LVETc与SV指导容量治疗能维持有效循环血容量,抑制炎性反应,适用于肝癌切除术患者.
목적 평개불동용량치료방법대간암절제술환자염성반응적영향.방법 택기행간암절제술환자40례,성별불한,년령40～60세,체중지수20～25 kg/m,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기수궤분위2조(n=20):상규보액조(Ⅰ조)화목표관리보액조(Ⅱ조).Ⅰ조보액량위보상성확용량+생리수요량+루계결실량+계속손실량+제삼간극주실량,보상성확용량우마취유도전이유산납림격씨액보충,보액량위5ml/kg,계속손실량안실혈량계산,이HES 130/0.4등량보충,제삼간극주실량채용유산납림격식액이5ml·kg·-1·h-1보충,생리수요량여루계결실량근거4-2-1법칙이유산납림격식액보충.Ⅱ조보상성확용치우마취유도전보충,방법동Ⅰ조,마취유도후정맥수주유산납림격씨액5 ml·kg-1·h-1,동시근거매박량(SV)화교정좌실사혈시간(LVETc)지도보액,유지LVETc 350～400 ms;350 ms＜ LVETc＜ 400 ms,차SV증가폭도＞10％시,칙계속정맥수주6％ HES 130/0.4,직지SV증폭≤10％.우마취유도전화술필시취정맥혈양,측정혈청TNF-α、IL-2、IL-4、IL-6화IL-8적농도,기록심혈관불량반응적발생정황.결과 여Ⅰ조비교,Ⅱ조TNF-α、IL-6급IL-8농도강저,IL-2화IL-4농도승고,저혈압화심동과속발생솔강저(P＜0.05).량조균미발생심혈관불량반응.결론 채용LVETc여SV지도용량치료능유지유효순배혈용량,억제염성반응,괄용우간암절제술환자.
Objective To investigate the effects of different methods of volume therapy on the inflammatory response in patients undergoing liver cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients,aged 40-60 yr,with body mass index 20-25 kg/m2,undergoing liver cancer resection,were randomly divided into 2 groups ( n =20 each):routine fluid replacement group (group Ⅰ ) and goal-directed fluid replacement group (group Ⅱ ).The fluid replacement regime in group Ⅰ =compensatory volume expansion (CVE) + physiological requirements + cumulative loss + confinued loss + the third space losses.CVE was replaced with lactated Ringer's (LR) solution 5 mg/kg before anesthesia induction.The physiological requirements and cumulative loss were replaced with LR solution according to the principle of 4-2-1.The continued loss equal to the intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl s tarch ( HES 130/0.4).The 3rd space losses were replaced with LR solution 5 ml·kg-1 ·h-1.In group Ⅱ,CVE was replaced with LR sol6ution as in group Ⅰ.LR solution was infused after anesthesia induction at 5 ml·kg-1 ·h-1.6％ HES was infused to maintain left ventricular ejection time (LVETc) between 350-400 ms.When 350 ms ＜ LVETc ＜ 400 ms and the amplitude of stroke volume ( SV ) increased by ＞ 10％,6％ HES was infused continuously until the amplitude of SV increased by ≤ 10％.Blood samples were taken before anesthesia induction and at the end of operation for measurement of serum TNF-α,IL-2,IL-4,IL-6 and IL-8 concentrations.The adverse cardiovascular reactions were recorded.Results Compared with group Ⅰ,the serum TNF-α,IL-6,IL-8 concentrations were significantly decreased,the serum IL-2 and IL-4 concentrations were significantly increase,and the incidence of hypotension and tachycardia was significantly decreased in group Ⅱ ( P ＜ 0.05).No adverse cardiovascular reactions were found in both groups.Conclusion LVETc and SV-guided volume therapy can maintain the blood volume and inhibit the inflammatory response and is suitable for the patients undergoing liver cancer resection.