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目的探讨目标导向液体治疗对脑膜瘤切除术患者脑代谢和手术后康复的影响。方法选取2007年8月至2015年8月间都江堰市人民医院收治的106例脑膜瘤患者,按照临床试验数字随机的方法将患者随机分为观察组和对照组,每组53例。观察组患者采用目标导向液体治疗,对照组患者采用常规的输液模式治疗,观察两组患者颈内静脉球部血氧饱和度、血氧分压、血氧含量、脑氧摄取率、乳酸含量和术后康复指标。结果观察组患者术中中心静脉压、平均动脉压和补液量均显著优于对照组,差异有统计学意义(P<0.05)。与诱导前比较,术中两组患者的血氧含量明显下降,而乳酸含量明显上升,差异均有统计学意义(P<0.05)。术中对照组患者的乳酸含量明显高于观察组,差异有统计学意义(P<0.05)。观察组患者术后24 h神经功能评分[(15.4±4.8)分]明显低于对照组[(18.1±2.4)分],差异有统计学意义(P<0.05)。两组患者出院时的卡氏体能状态评分[(81.9±6.1)分]明显高于术前[(70.1±7.0)分],差异有统计学意义(P<0.05);但两组间比较差异无统计学意义(P>0.05)。结论脑膜瘤切除术围手术期实施目标导向液体治疗,可稳定心指数,维持有效循环血容量,从而保证脑灌注、改善微循环,降低脑乳酸生成率,且可降低患者术后24 h神经功能缺损评分,但对早期生活质量无明显影响。
Objective To investigate the effects of targeted-guided liquid therapy on brain metabolism and postoperative rehabilitation in patients with meningiomas. Methods From June 2007 to August 2015, 106 patients with meningioma admitted to Dujiangyan People’s Hospital were randomly divided into observation group and control group according to the randomized clinical trial. Each group included 53 patients. Patients in the observation group were treated with target-directed fluid therapy. Patients in the control group were treated with conventional infusion mode. The oxygen saturation, oxygen saturation, oxygenation, brain oxygen uptake, Postoperative rehabilitation indicators. Results The intraoperative central venous pressure, mean arterial pressure and fluid volume in the observation group were significantly better than those in the control group, with significant difference (P <0.05). Compared with the pre-induction, the blood oxygen content in both groups decreased significantly, but the content of lactic acid increased obviously, the differences were statistically significant (P <0.05). The intraoperative control group patients lactic acid content was significantly higher than the observation group, the difference was statistically significant (P <0.05). The score of neurological function in the observation group at 24 hours after operation was significantly lower than that in the control group [(18.4 ± 4.8) points [(15.4 ± 4.8) points] (P <0.05). The cardiomyocyte state score [(81.9 ± 6.1)] at discharge from hospital was significantly higher than that before operation [(70.1 ± 7.0)], the difference was statistically significant (P <0.05); however, the difference between the two groups was significant No statistical significance (P> 0.05). Conclusions Perioperatively guided liquid therapy of meningiomas can stabilize the cardiac index and maintain the effective circulating blood volume, thus ensuring cerebral perfusion, improving microcirculation, decreasing the rate of cerebral lactic acid production, and decreasing the neurological function at 24 h after operation Defect score, but no significant effect on early life quality.