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目的探讨胸外术后毛细血管渗漏综合征(CLS)补液治疗策略。方法 29例胸外术后CLS患者按预后分为痊愈组和死亡组,按CLS病程分别统计术后早期(1~4天)和术后晚期(5~7天)患者日均平均动脉压(MAP)、中心静脉压(CVP)、血浆白蛋白(ALB)含量、尿量和胸液引流量作为疗效判断指标,统计日均晶体液、白蛋白、人工胶体和新鲜冰冻血浆使用,并分析两组补液策略差异。结果两组患者术后早期均存在低血容量和低白蛋白血症;治疗后痊愈组在术后晚期症状改善而死亡组继续恶化,其日均MAP、CVP、ALB、尿量均低于痊愈组,日均胸液引流量较高。痊愈组术后早期白蛋白和人工胶体使用量高于死亡组(P<0.05),而晶体液和血浆使用量比较,差异无统计学意义(P>0.05);术后晚期痊愈组白蛋白、人工胶体、血浆和晶体液使用量均低于死亡组(P<0.05)。结论胸外术后CLS补液治疗策略需根据病程分期进行,在术后早期充分补充白蛋白和人工胶体能够有效避免CLS持续进展。
Objective To investigate the treatment strategy of capillary fluid leakage syndrome (CLS) after thoracotomy. Methods Twenty-nine patients with CLS after thoracic surgery were divided into recovery group and death group according to the prognosis. According to the CLS duration, the average daily mean arterial pressure (LVEF) was calculated in patients with early stage (1-4 days) and late stage (5-7 days) (MAP), central venous pressure (CVP), albuminuria (ALB), urine volume and drainage of pleural effusion were used as indicators of therapeutic effect. Daily average crystalloid fluid, albumin, artificial colloids and fresh frozen plasma were used for statistical analysis. Group rehydration strategy differences. Results Both patients had hypovolemia and hypoalbuminemia in the early postoperative period. After treatment, the patients in the recovered group showed worse symptoms in the late postoperative period and the death group continued to deteriorate. The average daily MAP, CVP, ALB and urine output were lower than those in the cured group Group, the average daily discharge of pleural fluid higher. The use of albumin and artificial colloid in the early recovery group was higher than that in the death group (P <0.05), while there was no significant difference in the amount of crystalloid and plasma between the two groups (P> 0.05) Artificial colloid, plasma and crystal fluid usage were lower than the death group (P <0.05). Conclusion CLS rehydration therapy after thoracic surgery should be based on the stage of the disease, in the early postoperative full complement of albumin and artificial colloids can effectively prevent the continued progress of CLS.