發(fā)布時(shí)間：2018-05-10 23:40

  本文選題：液體治療 + 血流動(dòng)力學(xué)��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的：目前液體治療仍存在爭議。本研究通過觀察幾種不同性質(zhì)的液體治療策略對甲狀腺癌手術(shù)患者術(shù)中機(jī)體內(nèi)環(huán)境的影響。觀察術(shù)中患者內(nèi)環(huán)境的變化，，為液體治療策略提供一定的臨床依據(jù)。 方法：選擇40名ASA分級I-II級擬擇期進(jìn)行甲狀腺癌手術(shù)的患者，年齡在30-60歲之間，預(yù)計(jì)手術(shù)時(shí)間在2.5-5小時(shí)，隨機(jī)分為A、B、C、D四組。所有患者在入手術(shù)室之前進(jìn)行常規(guī)的術(shù)前準(zhǔn)備。入手術(shù)室后進(jìn)行持續(xù)的心電（ECG）、心率（HR）、血壓(BP)、血氧飽和度（SpO2）監(jiān)測。所有患者進(jìn)行常規(guī)全憑靜脈麻醉方法麻醉�；颊咴陂_放通路后，按10ml/kg·h的速度輸入醋酸鈉林格注射液。30min后進(jìn)行麻醉誘導(dǎo)，誘導(dǎo)結(jié)束后，A組以20ml/kg·h輸入醋酸鈉林格注射液，B組C組D組以同樣的速度輸入羥乙基淀粉130/0.4氯化鈉注射液，輸入30min。30min后手術(shù)開始，此時(shí)A組B組更換為0.9%氯化鈉注射液C組更換為轉(zhuǎn)化糖注射液D組更換為醋酸鈉林格注射液，四組均已10ml/kg·h的速度輸入。60min后A、B、C、D四組均更換為0.9%氯化鈉溶液以10ml/kg·h輸入速度至手術(shù)結(jié)束。本研究將麻醉誘導(dǎo)即刻設(shè)為T1，手術(shù)開始前即刻設(shè)為T2，手術(shù)開始60min設(shè)為T3，術(shù)終設(shè)為T4。在T1-T4四個(gè)時(shí)間點(diǎn)分別記錄HR、BP、ECG、SpO2，并采集動(dòng)脈血2ml進(jìn)行血?dú)夥治龊脱菧y定。 結(jié)果：40名患者均順利完成本研究。 在血流動(dòng)力學(xué)方面：四組患者在T1時(shí)刻BP及HR無明顯差異（P＞0.05）無統(tǒng)計(jì)學(xué)意義。在T2-T4各時(shí)間點(diǎn)A組與其它組相比較BP低于基礎(chǔ)值（P＜0.05）有統(tǒng)計(jì)學(xué)意義。四組患者在T2時(shí)間點(diǎn)HR均降低（P＜0.05）。HCT比較，在T2時(shí)間點(diǎn)各組HCT均降低與T1比較有統(tǒng)計(jì)學(xué)意義(P＜0.05)。T3-T4段A組HCT恢復(fù)至麻醉前水平（P＞0.05），B、C、D三組HCT仍保持在較低水平（P＜0.05）。在T1、T2時(shí)刻四組比較無明顯差異（P＞0.05），T3、T4時(shí)刻A組HCT高于其它三組(P＜0.05)。 電解質(zhì)及血糖方面：Na+比較，C組在T3、T4時(shí)間點(diǎn)Na+低于基礎(chǔ)水平（P＜0.05），組間比較C組低于A、B、D三組（P＜0.05）；K+比較，B、D組K+在T2—T4段低于基礎(chǔ)水平（P＜0.05），C組在T+2時(shí)間點(diǎn)K降低（P＜0.05），T3時(shí)間點(diǎn)之后恢復(fù)到基礎(chǔ)水平（P＞0.05）；Ca2+比較，B、C、D三組在T2-T2+4段Ca均低于基礎(chǔ)水平（P＜0.05），A組無明顯變化（P＞0.05）；血糖比較，C組在T3-T4段血糖高于基礎(chǔ)值（P＜0.05），其它三組無明顯變化（P＞0.05）。 酸堿平衡方面：PH比較：A組在T3-T4段PH值降低（P＜0.05）有統(tǒng)計(jì)學(xué)意義，B、C、D三組在T2-T4段PH值降低（P＜0.05）；SB比較，A組在T2-T4段SB高于其它組（P＜0.05）；BE比較，A組在T2-T3段BE值高于其它三組（P＜0.05），T1、T4時(shí)間點(diǎn)無明顯差異（P＞0.05）。 結(jié)論： 1.醋酸鈉林格氏液成分接近人體內(nèi)環(huán)境電解質(zhì)和PH值，能維持術(shù)中患者機(jī)體內(nèi)環(huán)境的穩(wěn)定； 2.轉(zhuǎn)化糖能夠?yàn)榛颊咛峁┠芰坎⒛苎a(bǔ)充K+濃度但會(huì)對血糖造成影響； 3.羥乙基淀粉130/0.4氯化鈉能維持患者術(shù)中血流動(dòng)力學(xué)的穩(wěn)定，但會(huì)引起血液的稀釋，造成K+、Ca2+稀釋性降低。
[Abstract]:Objective: liquid therapy is still controversial. In this study, we investigated the effects of different liquid therapy strategies on the intraoperative environment of thyroid cancer patients. To observe the changes of patients' internal environment during operation and to provide some clinical basis for liquid therapy strategy. Methods: forty patients with thyroid carcinoma, aged 30 to 60 years old and estimated to be operated for 2.5 to 5 hours, were randomly divided into four groups. All patients underwent routine preoperative preparation before entering the operating room. After entering the operating room, continuous monitoring of ECG, HRT, BP, SPO _ 2 was performed. All patients were anesthetized by routine intravenous anesthesia. After opening the pathway, the patients were induced by anesthesia at the rate of 10ml/kg h after injection of Ringer sodium acetate injection for 30 minutes. After induction, group A was infused with sodium acetate Ringer injection with 20ml/kg h. Group B, group C, group D, were infused with hydroxyethyl starch 130 / 0.4 sodium chloride injection at the same speed, and the operation began after the injection of 30min.30min. Group B was replaced by 0.9% sodium chloride injection. Group C was replaced by transforming sugar injection. Group D was replaced by sodium acetate Ringer injection. All the four groups were given the velocity of 10ml/kg h. 60 minutes later, the four groups were replaced with 0.9% sodium chloride solution at the rate of 10ml/kg h to the end of the operation. In this study, anesthesia induction was established as T _ 1, T _ 2 immediately before operation, 60min as T _ 3, and T _ 4 as the end of operation. The blood gas analysis and blood glucose measurement were performed at four time points of T1-T4. Results all 40 patients successfully completed the study. In hemodynamics, there was no significant difference in BP and HR between the four groups at T1 (P > 0.05). The BP of group A was lower than that of other groups at each time point of T2-T4 (P < 0.05). The HR of the four groups was significantly lower than that of the control group at T2 time point (P < 0.05).HCT). At T2 time point, the HCT of each group was significantly lower than that of the T1 group. The HCT of group A returned to the level before anesthesia (P > 0.05) and the HCT of the three groups remained at a lower level (P < 0.05). There was no significant difference between the four groups at T _ 1 T _ 2 and T _ 3 T _ 4 (P > 0.05). The HCT of group A was higher than that of the other three groups (P < 0.05). Comparison of electrolyte and blood glucose Na in group C is lower than basic level at T _ 3T _ 4 (P < 0.05), P < 0.05T _ 3 in group C is lower than that in group C (P < 0.05); K in group C is lower than basic level in T2-T4 (P < 0.05); K in group C is lower than that at T _ 2 (P < 0.05); T _ 3 in group C is lower than that in group C (P < 0.05); T _ 3 is lower in group C than in group C (P < 0.05). A comparison of Ca ~ (2 +) in T2-T2 _ 4 between the three groups (P < 0.05) but no significant change in the basal level (P < 0.05), blood glucose in group C (P < 0.05) was higher than that in the basic level (P < 0.05), and there was no significant change in the other three groups (P > 0.05). The level of Ca ~ (2 +) in group C was higher than that in the basic level (P < 0.05), while that in group C was higher than that in group A (P < 0.05). The PH value of group A was significantly lower than that of group A in T3-T4 (P < 0.05). There was no significant difference between group A and group A (P < 0.05). There was no significant difference (P > 0.05) between group A and group A in T2-T3 segment (P < 0.05), group A (P < 0.05), group A (P < 0.05) and group A (P < 0.05). Conclusion: 1. The composition of Ringer's solution of sodium acetate is close to the environmental electrolyte and PH value of human body, which can maintain the stability of the patient's internal environment during operation. 2. Transforming sugar can provide energy for patients and supplement K concentration, but it can affect blood sugar. 3. Hydroxyethyl starch 130 / 0.4 sodium chloride can maintain the hemodynamic stability of patients during operation, but it will cause hemodilution and decrease of K ~ (2 +) Ca ~ (2 +) dilution.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R736.1

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