【作者】 陈婉南；

【导师】 薛张纲；

【作者基本信息】 复旦大学 ， 麻醉学， 2012， 博士

【摘要】 [目的]补液量和补液种类长期以来都是围手术期液体治疗策略的争论焦点。新近的研究结果显示以目标导向方式补充液体可以降低某些手术围术期并发症的发生率,进而有人提出该作用还可能与补充的液体种类有关。本研究旨在明确术中以目标导向方式输注较晶体或胶体液是否影响快通道结直肠手术的短期结局。[方法]选取2010年12月至2011年8月期间,复旦大学附属中山医院普外科收治的接受快通道结直肠癌根治术患者16例,随机分为两组,万汶组(HES组)和生理盐水组(NS组),每组病例8例。术中以乳酸林格氏液为基础补液,以SVV变化为参考补充6%羟乙基淀粉130/0.4(HES组)或0.9%生理盐水(NS组)以达到理想血流动力学目标。比较两组患者的术后适合出院时间；手术后的体重变化；术后恶心、呕吐发生率；围手术期凝血功能、心衰指数等变化。观察在目标导向的液体治疗中,6%羟乙基淀粉130/0.4(万汶)相较于0.9%生理盐水是否能改善患者的短期结局。适合出院天数以中位数(95%可信区间)表示,其他计量资料以平均数±标准差表示,所有数据均由SPSS16.0统计软件进行统计学处理,以P<0.05为有显著统计学意义。[结果]16例入组患者均完成研究。两组患者的一般人口学资料与临床资料间无显著的统计学差异。在实施开腹快通道结直肠癌根治术后,HES组患者相较于NS组患者的适合出院时间的中位数少14.5小时；HES组患者术中补液少于NS组患者(P<0.01),HES组患者术中尿量少于NS组患者术中尿量(P<0.01)；两组患者术后并发症无明显差异(P>0.05)；围手术期凝血功能变化无明显差异(P>0.05)；围手术期心衰指数变化无明显差异(P>0.05)。[结论]在快通道结直肠癌根治术中以SVV为指导的目标导向液体治疗中,术中使用HES的患者适合出院天数低于术中使用NS的患者。但限于样本数量及患者的围手术期评价频度,本实验中此差异无统计学差异,但从本研究的实施情况看,研究的初始方案可行性较强。如果需明确HES对此类手术的短期结局到底有无影响,应按计划扩大研究的样本量,进行多中心研究；如需要减少研究样本,则需加大术后评价频度。更多还原

【Abstract】 [Objective] There are many conflicts on the type and the amount of fluid in peri-operactive fluid management. Recent researches show that goal-directed fluid therapy may reduce postoperative complications and benefit better outcome. However this benefit is thought to be the usage of colloid but lacking of evidence. So in this study we try to find out whether artificial colloid (6%HES130/0.4) can really do better than normal saline in affecting short term outcome of fast-track open colorectal surgery, if given by goal directed strategy.[Methods]16patients who received open colorectal surgery in Zhongshan Hospital department of general surgery from December2010to August2011would be enrolled in this study and equally divided into two groups(HES group and NS group) by random. Ringer’s solution would be given as a background fluid infusion during the surgery, and under the guidance of SVV,6%HES130/0.4or0.9%NS would be given as bolus fluid in either group to reach the setting hemodynamic goal. We compared the time fit for discharge and post-operative complications such as nausea and vomiting, pre and post-operative PT, APTT, NT-pro-BNP and re-hospitalization rate etc. The hypothesis is that6%HES130/0.4can improve patients’short term outcome. All the data would be analyzed by SPSS16.0, the time fit for discharge will be expressed in median value(95%CI) and the other quantitative value will be expressed in mean value±SD. P<0.05is regarded as significant statistical difference.[Results] All the16enrolled patients finished the study. There was no significant difference between two groups in general demographic information and clinical information. The time fit for discharge in HES groups is14.5hours less than that in NS group. Compared with NS group, HES group received much less fluid infusion(P<0.01), and had much less urinary output during the operation(P<0.01). There are no significant differences in occurrence of post-operative complications, peri-operative PT, APTT, NT-pro-BNP changing between two groups(P>0.05). [Conclusion] It seemed that compared with NS, intra-operative goal directed infusing6%HES130/0.4can shorten in-hospital time of fast-track open colorectal surgery. However, as the sample size is too small, the difference is not statistical significant. According to this research, the designated protocol is applicable and it is valuable to apply a multiple-center research to prove positive effect of HES on out come of fast-track surgery. If allowed, increasing the frequency of fit for discharge evaluation may help to reduce the sample size.更多还原