CAJ | 학술논문

目的：分析不同晶体胶体比例输液对颅脑手术患者术中血流动力学和血气指标的影响。方法选取行颅脑手术患者60例作为研究对象，随机分为A、B、C、D 4组，每组各15例，其中A组为单纯输注晶体液，其余3组输注的晶体液与胶体液的比例分别为2∶1、1∶1和1∶2。在入室后10 min及穿刺置管完毕（T1）、去除骨瓣（T2）、切除肿瘤后（T3）和手术结束（T4）等4个时间点，对4组患者的平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）等血流动力学指标和pH值、二氧化碳分压（PaCO2）、红细胞比积（Hct）、血氧分压（PaO2）等血气指标进行连续监测和分析。结果4组患者的MAP、HR、CVP等血流动力学指标在术中各监测时点差异无统计学意义（组内变异，P＞0.05），各监测时点的MAP、HR、CVP等血流动力学指标4组患者差异无统计学意义（组间变异，P＞0.05）；各监测时点的pH值、PaCO2、Hct、PaO2水平在4组患者间差异无统计学意义（组间差异，P＞0.05），4组患者的pH值、PaCO2、PaO2水平在术中各监测时点的差异无统计学意义（组内差异，P＞0.05），而4组患者的 Hct水平在术中各监测时点差异有统计学意义（组内差异，P＜0.05），其水平随着手术时间的推移而呈现下降趋势。结论4种配比的输液方式对颅脑手术患者的血流动力学指标和血气指标的影响基本相当，且均可控制在较为安全的范围，可维持较为稳定的脑供需氧平衡，但需对患者血细胞浓度情况进行综合监测。
목적：분석불동정체효체비례수액대로뇌수술환자술중혈류동역학화혈기지표적영향。방법선취행로뇌수술환자60례작위연구대상，수궤분위A、B、C、D 4조，매조각15례，기중A조위단순수주정체액，기여3조수주적정체액여효체액적비례분별위2∶1、1∶1화1∶2。재입실후10 min급천자치관완필（T1）、거제골판（T2）、절제종류후（T3）화수술결속（T4）등4개시간점，대4조환자적평균동맥압（MAP）、심솔（HR）、중심정맥압（CVP）등혈류동역학지표화pH치、이양화탄분압（PaCO2）、홍세포비적（Hct）、혈양분압（PaO2）등혈기지표진행련속감측화분석。결과4조환자적MAP、HR、CVP등혈류동역학지표재술중각감측시점차이무통계학의의（조내변이，P＞0.05），각감측시점적MAP、HR、CVP등혈류동역학지표4조환자차이무통계학의의（조간변이，P＞0.05）；각감측시점적pH치、PaCO2、Hct、PaO2수평재4조환자간차이무통계학의의（조간차이，P＞0.05），4조환자적pH치、PaCO2、PaO2수평재술중각감측시점적차이무통계학의의（조내차이，P＞0.05），이4조환자적 Hct수평재술중각감측시점차이유통계학의의（조내차이，P＜0.05），기수평수착수술시간적추이이정현하강추세。결론4충배비적수액방식대로뇌수술환자적혈류동역학지표화혈기지표적영향기본상당，차균가공제재교위안전적범위，가유지교위은정적뇌공수양평형，단수대환자혈세포농도정황진행종합감측。
Objective To observe and analyze the effects of different transfusion crystalloid-colloid ratio on hemodynamics and blood gas indexes of the patients with craniocerebral operation .Methods Sixty patients with craniocerebral operation were selected as the research objects and randomly divided into the four groups of A ,B ,C and D .Fifteen cases were included into each group .The patients in group A were treated with crystalloid infusion ,while crystalloid and colloid liquid ratios which were used in the treatment of the patients in the remaining three groups were 2︰1 ,1︰1 and 1︰2 ,respectively .At the four time points of 10th min after entering the operating room and puncture (T1 ) ,after removal of bone flap (T2 ) ,after tumor resection (T3 ) and at the end of operation (T4 ) ,the hemodynamics indexes of the mean artery pressure (MAP) ,heart rate (HR) ,central vein pressure (CVP) and the blood gas indexes of pH ,carbon dioxide (PaCO2 ) ,hematocrit (Hct) ,partial pressure of oxygen (PaO2 ) of the patients in the four groups were monitored and analyzed continuously .Results The differ-ences of the hemodynamic indexes such as MAP ,HR ,CVP between the patients in the four groups at each monitoring points were not significant (within group variation ,P>0 .05) ,the differences of MAP ,HR ,CVP in the four groups between each monitoring points were not significant (between group variation ,P>0 .05);the differences of the blood gas indexes such as pH ,PaCO2 ,Hct ,PaO2 between the patients in the four groups at each monitoring points were not significant (within group variation ,P>0 .05) ,the differences of pH ,PaCO2 ,PaO2 in the four groups between each monitoring points were not signifi-cant (between group variation ,P>0 .05) ,while the differences of Hct in the four groups between each monitoring points were significant (between group variation ,P<0 .05) and the levels decreased a downward trend as operation time went .Conclusion The influences of four infusion treatment with different crystalloid-colloid ratio on the hemodynamics and blood gas indexes of the patients with craniocerebral operation are basically the same .These indexes can be controlled in the range of safe and a rela-tively stable cerebral oxygen balance can be maintained .However ,the blood cell concentration of the patients needs to be inte-grated monitored .