CAJ | 학술논문

目的观察食管超声多普勒监测仪(transesophageal echocardiography,TEE)指导下目标导向液体治疗(goaldirected therapy,GDT)对大肠癌手术患者术中循环、组织灌注及术后恢复的影响. 方法 65岁以下择期硬膜外复合全麻大肠癌根治术患者60例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,按随机数字表法分为两组(每组30例):TEE指导下GDT组(T组)和传统液体治疗组(C组).麻醉后T组根据每搏量(stroke volume,Sv)和纠正左室射血时间(corrected left ventricular ejectiontime,LVETc)指导液体输入,C组按传统方法补液.记录两组患者麻醉前(T1)、插管前(T2)、开腹探查(T3)、肿物切除(T4)、关腹(T5)和拔管后(T6)平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)、中心静脉压(central venous pressure,CVP)的变化,各时点输液量、液体总量和尿量.分别在手术开始前、肿物切除后、术毕测定血清D-乳酸(lactic acid,LAC)含量,观察术后排气、排便时间,进流食时间,术后恶心呕吐发生率,住院天数及其他并发症. 结果 MAP、HR两组组内T2、T3较麻醉前(T1)降低(P＜0.01),CVP组内比较,T2较T1增高(P<0.01);与T组比较,C组CVP在T4、T5、R时点增高(P＜0.01).C组补液量在T3低于T组,T4、T5、T6高于T组(P＜0.05),C组液体总量多于T组(P＜0.01),尿量T组少于C组(P＜0.05).LAC各时点组内组间比较,差异无统计学意义(P＞0.05).T组术后排气、排便时间[(3.2±0.7)、(4.5±0.9)d]明显短于C组[(4.7±0.3)、(5.9±0.7)d](P＜0.05),进流食时间T组[(2.84±0.14)d]早于C组[(3.95±0.72)d](P＜0.05).C组术后恶心呕吐发生率、住院天数[30％、(11.3±2.3)d]高于T组[13％、(8.2±3.4)d](P＜0.05). 结论硬膜外复合全麻肠癌手术中采用GDT在合理输液和加速患者术后胃肠功能恢复上具有优势.
목적 관찰식관초성다보륵감측의(transesophageal echocardiography,TEE)지도하목표도향액체치료(goaldirected therapy,GDT)대대장암수술환자술중순배、조직관주급술후회복적영향. 방법 65세이하택기경막외복합전마대장암근치술환자60례,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급,안수궤수자표법분위량조(매조30례):TEE지도하GDT조(T조)화전통액체치료조(C조).마취후T조근거매박량(stroke volume,Sv)화규정좌실사혈시간(corrected left ventricular ejectiontime,LVETc)지도액체수입,C조안전통방법보액.기록량조환자마취전(T1)、삽관전(T2)、개복탐사(T3)、종물절제(T4)、관복(T5)화발관후(T6)평균동맥압(mean artery pressure,MAP)、심솔(heart rate,HR)、중심정맥압(central venous pressure,CVP)적변화,각시점수액량、액체총량화뇨량.분별재수술개시전、종물절제후、술필측정혈청D-유산(lactic acid,LAC)함량,관찰술후배기、배편시간,진류식시간,술후악심구토발생솔,주원천수급기타병발증. 결과 MAP、HR량조조내T2、T3교마취전(T1)강저(P＜0.01),CVP조내비교,T2교T1증고(P<0.01);여T조비교,C조CVP재T4、T5、R시점증고(P＜0.01).C조보액량재T3저우T조,T4、T5、T6고우T조(P＜0.05),C조액체총량다우T조(P＜0.01),뇨량T조소우C조(P＜0.05).LAC각시점조내조간비교,차이무통계학의의(P＞0.05).T조술후배기、배편시간[(3.2±0.7)、(4.5±0.9)d]명현단우C조[(4.7±0.3)、(5.9±0.7)d](P＜0.05),진류식시간T조[(2.84±0.14)d]조우C조[(3.95±0.72)d](P＜0.05).C조술후악심구토발생솔、주원천수[30％、(11.3±2.3)d]고우T조[13％、(8.2±3.4)d](P＜0.05). 결론 경막외복합전마장암수술중채용GDT재합리수액화가속환자술후위장공능회복상구유우세.
Objective To observe the application of goal-directed therapy (GDT) directed by transesophageal echocardiography (TEE) in patients of cutting colon cancer operation.Methods Sixty scheduled colon cancer patients with epidural plus general anesthesia were randomly divided into routine fluid therapy group (group C) and GDT group monitered with TEE (group T) using random digits table (n=30).The patients of group C were infused routinely after anesthesia,the patients of group T were infused under monitered stroke volume (SV) and corrected left ventricular ejection time (LVETc) with TEE.Mean artery pressure (MAP),heart rate (HR),the amount of infused fluid,central venous pressure (CVP) of two groups were recorded before anesthesia (T1),tracheal intubation (T2),the time point of abdomen exploration (T3),cuting goiter (T4),closing abdomen (T5) and after extubation (T6).The total amount of infusion fluid and urine volume were recorded at the end of operation.The plasma amount of D-lactic acid were monitered at the time point of preoperation,after cuting goiter and the end of operation.Postoperation time of air bleed,defecate Liquid Diet were monitored.Postoperative nausea emesia,various complications,the time to take food,hospital day were observed.Results The MAP and HR of T2 and T3 were lower than before anesthesia (P＜0.01),there were no significant difference among other time.The CVP of all groups at T2 were higher than T1,the CVP of group T was higher than group C at the point of T4,T5 and T6 (P＜0.01).There were significantly diffferent between two groups about amount of fluid replacement at the time point of T3,T4,T5 and T6 (P＜0.05).The urine volume of group T was less than that of group C.There were no significant difference about LAC between two groups.The morbidity of nausea of C group [(4.7±0.3) d] was higher than group T [(3.2±0.7) d](P＜0.05).The air bleed,defecate time of group T [(2.84±0.14) d] were significant shorter than group C [(3.95±0.72) d](P＜0.05),liquid diet time of group T [(4.5±0.9) d] was earlier than group C [(5.9±0.7) d)](P＜0.05),the incidence of postoperative nausea and vomiting and the inhospital day of group T [13％,(8.2±3.4) d] was less than that of group C [30％,(11.3±2.3) d)](P＜0.05).Conclusions GDT provides obviously dominant postoperative outcome for patients with operation of cutting colon cancer.