CAJ | 학술논문

目的探讨围术期限制性输液对老年开腹手术患者肝、肾功能的影响。方法将60岁以上择期行腹部手术患者60例按随机数字表法分为两组：S组30例为常规输液组，围术期按常规补液方案进行补液；R组30例为限制性补液组，麻醉诱导前至进腹1 h内补累积缺失量的1/2，之后每15 min测1次中心静脉压（ CVP），维持CVP的数值在5～7 cm H2 O，输液速度约为4 ml· kg -1· h-1。两组晶、胶体输入比均为2∶1。比较两组术前、术后24 h肝、肾功能指标以及术后并发症、胃肠道恢复时间和术后住院时间。结果 R组液体输入总量显著少于S组（P＜0．05）。 R组术后血谷草转氨酶（AST）水平高于术前（P＜0．05），但尚处于正常范围；两组术后血谷丙转氨酶（ALT）、尿素氮、肌酐水平与术前比较，差异均无统计学意义（P＞0．05）；与S组比较，R组术后并发症发生率低，胃肠道功能恢复时间快，术后住院时间短（ P均＜0．05）。结论老年人腹部手术中采用限制性输液方案是安全可行的。
목적탐토위술기한제성수액대노년개복수술환자간、신공능적영향。방법장60세이상택기행복부수술환자60례안수궤수자표법분위량조：S조30례위상규수액조，위술기안상규보액방안진행보액；R조30례위한제성보액조，마취유도전지진복1 h내보루적결실량적1/2，지후매15 min측1차중심정맥압（ CVP），유지CVP적수치재5～7 cm H2 O，수액속도약위4 ml· kg -1· h-1。량조정、효체수입비균위2∶1。비교량조술전、술후24 h간、신공능지표이급술후병발증、위장도회복시간화술후주원시간。결과 R조액체수입총량현저소우S조（P＜0．05）。 R조술후혈곡초전안매（AST）수평고우술전（P＜0．05），단상처우정상범위；량조술후혈곡병전안매（ALT）、뇨소담、기항수평여술전비교，차이균무통계학의의（P＞0．05）；여S조비교，R조술후병발증발생솔저，위장도공능회복시간쾌，술후주원시간단（ P균＜0．05）。결론노년인복부수술중채용한제성수액방안시안전가행적。
Objective To explore the effects of intravenous fluid restriction on hepato-nephro function in eld-erly patients undergoing intra-abdominal operation .Methods Sixty patients older than 60 years who were undergoing elective operation on abdominal region were randomly divided into two groups ,30 cases in the standard group ( Group S) while 30 cases in the restriction group ( Group R) .In the standard group ,fluid management according to the stand-ard fluid administration was performed .In the restriction group ,patients were administered a half of accumulative fluid loss within one hour before anaesthesia induction , and their central venous pressure ( CVP ) , which ranged from 5 cmH2 O to 7 cmH2 O,was measured once every 15 minutes,the initial infusion rate was 4 ml· kg -1 · h -1 .The ratio of crystals input to colloid input was 2:1 in both groups .A comparison of the indices of hepato-nephro function before operation and 24 hours after operation as well as the postoperative complications ,the time of digestive tract function re-covery and length of stay was conducted between two groups .Results The total volume of fluid infusion in the Group R was significantly smaller than that in the Group S (P<0.05).The level of postoperative aspartate aminotransferase (AST) was higher than the preoperative one in the Group R (P<0.05),which also within the normal range;There was no significant difference in the alanine aminatransferase (ALT),blood urea nitrogen(BUN),creatinine(Cr) be-tween the preoperative and the postoperative in both groups (P>0.05);Compared with Group S,the incidence of postoperative complications was lower in the Group R as well as the time of digestive tract function recovery and length of stay were significantly shorter (all P<0.05).Conclusion Restrictive fluid management applied to elderly patients undergoing abdominal surgery is safe and feasible .