【摘要】 目的:探讨在老年人开腹手术中采用限制性输液对患者血液流变学和血清S100B蛋白的影响。方法:选择60岁以上择期行开腹手术病人60例,随机分为2组,每组30例。常规输液组(S组):输入液体总量=补偿性扩容+生理需要量+累计缺失量+继续损失量+第三间隙缺失量。限制输液组(R组):麻醉诱导前至进腹约60min内补累积缺失量的1/2,之后输液速度为4mL/kg.h-1,每15min测中心静脉压(CVP),维持CVP在0.49～0.69kPa。两组晶、胶体比均为2∶1。两组均在麻醉前(T1)、术中2h(T2)、术毕拔管后30min(T3)、术后24h(T4)检测患者血液流变学指标及血清S100B蛋白含量,观察术后并发症的情况。结果:R组术中液体输入总量低于S组(P<0.05);R组术中CVP显著低于S组(P<0.05);R组术中2h及术毕拔管后30min血液流变学各项指标与S组相比有明显变化(P<0.05)。两组术中、术后S100B蛋白水平分别与术前比较均没有明显差异(P>0.05)。R组与S组比较,术后总体并发症发生率较少(P<0.05)。结论:老年人开腹手术中采用4mL/kg.h-1的限制性输液方案是安全的,不增加血液黏滞度,对S100B蛋白水平亦无明显影响。更多还原

【Abstract】 Objective:To investigate the effects of intravenous fluid restriction on hemorheology and cTnI in old patients undergoing intraabdominal surgery.Methods: Sixty patients older than 60 years who were undergoing elective intraabdominal surgery.Patients were randomly assigned to receive a standard group(n=30) or a restricted group(n=30).In the standard group: Rate of fluid administration=CVE+deficit+maintenance+loss+third space.In the restricted group,patients were administered half of deficit before the surgery,then the initial infusion rate was 4 mL/kg·h-1,central venous pressure(CVP) was measured every 15 minutes and maintained it at 0.49~0.69 kPa.In both groups crystals and colloid’s ratio was 2∶1,the crystal choose to use the lactated Ringer’s solution,and the colloid choose the 6%HS130/0.4(Voluven).In both groups,the venous blood samples were taken for determination of hemorheological parameters and serum concentrations of S100B and before anesthesia(T1),2 hours after skin incision(T2),30 min after extubation(T3),24 hours after the operation(T4).The postoperative morbidity,recovery of bowel function and hospital stay was measured after the patients returned to the ward.Results: The intraoperative volumes of fluid administered in the restricted group was significantly lower than the standard group(P<0.05);The CVP in restricted group was significantly lower than that in standard group(P<0.05);at T2 and T3 the restricted group of hemorheological parameters(the whole-blood viscosity and plasma viscosity,hematocrit) compared with the standard group had significant differences(P<0.05).At T2 the serum concentrations of S100B and in restricted group had no significant differences with standard group(P>0.05),and there were no significant differences with preoperative(P>0.05).The number of patients with postoperative complications in restricted group was lower than that in the standard group.Conclusion: It’s safe,feasible and advantageous to use of restrictive fluid management during elderly patients undergoing elective intraabdominal surgery.更多还原