论文部分内容阅读
目的探析目标导向液体治疗(GDT)对胶质瘤开颅术患者预后的影响,神经外科病人的液体管理理论参考。方法 2011年10月至2014年7月在我院接受胶质瘤开颅术治疗的44例患者的临床资料。随机将患者分为观察组(目标导向液体治疗组,G组)和对照组(常规治疗组,C组)两组,每组22例。比较两者患者的基线资料、血渗透压、液体治疗方案、住院时间、术后并发症的发生率、血液动力学相关指标、氧供应相关指标以及不同时刻血S100-β与血乳酸的浓度。结果两组患者的年龄、ASA分级、BMI、性别构成比无统计学差异(P>0.05)。G组患者手术期间的液体总量、胶体用量(130/0.4 6%的羟乙基淀粉)以及尿输出量高于C组(P<0.05)。血渗透压、出血量、输血量以及晶体用量(复方NaCl注射液用量)组间比较均无统计学差异(P>0.05)。两组患者都无脑水肿以及感染等并发症发生;G组的住院时间明显短于C组,差异有统计学意义(P<0.05)。G组在手术完成时(T3)的氧供指数(DO2I)、中心静脉血氧饱和度(ScvO2)、心指数(CI)、中心静脉压(CVP)以及平均血压(MBP)值均高于C组(P<0.05);G组患者T4血S100-β以及T3、T4血乳酸的浓度均低于C组患者(P<0.05);G组患者T3、T4时刻的血乳酸与S100-β浓度均比T1时刻低(P<0.05)。结论胶质瘤开颅术患者在麻醉过程中接受GDT治疗可以显著改善其预后的情况。
Objective To investigate the effect of target-directed fluid therapy (GDT) on the prognosis of patients with glioma undergoing craniotomy and the reference of fluid management theory for neurosurgical patients. Methods The clinical data of 44 patients with glioma craniotomy who were treated in our hospital from October 2011 to July 2014 were retrospectively analyzed. Patients were randomly divided into observation group (target-oriented liquid therapy group, G group) and control group (conventional treatment group, C group) two groups, each group of 22 cases. Baseline data, blood osmotic pressure, fluid treatment regimen, hospitalization duration, incidence of postoperative complications, hemodynamic parameters, indicators of oxygen supply, and serum S100-β and blood lactate concentrations at different time points were compared between the two groups. Results There was no significant difference in age, ASA classification, BMI and sex composition between the two groups (P> 0.05). The total amount of fluid during operation, amount of gel (130 / 0.4 6% hydroxyethyl starch) and urine output in group G were higher than those in group C (P <0.05). Blood osmotic pressure, blood loss, blood transfusion volume and crystal dosage (compound NaCl injection) were no significant difference between groups (P> 0.05). There were no cerebral edema and complications such as infection in both groups. The length of stay in group G was significantly shorter than that in group C (P <0.05). The oxygen index (DO2I), central venous oxygen saturation (ScvO2), cardiac index (CI), central venous pressure (CVP) and mean blood pressure (MBP) in group G at the end of operation were higher than those in group C (P <0.05). The serum levels of T4 blood S100-β and T3, T4 blood lactate in group G were lower than those in group C (P <0.05). The levels of serum lactate and S100-β in group G at T3 and T4 All lower than T1 (P <0.05). Conclusions Patients with glioma who underwent craniotomy receiving GDT during anesthesia could significantly improve their prognosis.