發(fā)布時間：2018-05-21 06:00

  本文選題：限制性輸液 + 結腸癌切除術�。� 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討限制性輸液對腹腔鏡下結腸癌切除術患者術后相關并發(fā)癥的影響。方法:選取擇期擬在全麻下行結腸癌切除術的患者80例,年齡35~70歲,體重指數(shù)(Body mass index,BMI)18~30Kg/m2,ASA分級Ⅰ~Ⅱ級,采用隨機數(shù)字表法,將患者分為2組:限制輸液組(R組)和非限制輸液組(L組),限制性輸液組:麻醉誘導前至手術結束,與輸液速度為6ml/(Kg.h),監(jiān)測中心靜脈壓(CVP),維持CVP在5~8cmH2o。非限制性輸液組:輸注液體總量=補償性擴容量+生理需要量+累計缺失量+繼續(xù)損失量+第三間隙缺失量。兩組晶,膠體比均為2∶1。兩組均在麻醉前(T1)、手術開始后1小時(T2)、術后24h(T3)檢測患者動脈血氣分析指標;于手術前24h,術后24h檢測肝功能、腎功能;觀察術后并發(fā)癥的情況。結果:1.兩組患者在一般情況及手術時間的差異無統(tǒng)計學意義(P0.05)。2.兩組患者在手術時間、拔管時間、術中出血量及尿量的差異無統(tǒng)計學意義(P0.05)。3.兩組患者,在T1、T2、T3時間點的PO2、PCO2、BE、Hb比較,差異無統(tǒng)計學意義(P0.05)。與R組比L組在T2及T3時間點的Hct降低,差異有統(tǒng)計學意義(P0.05),同組患者與T1時間點比較,T2及T3的Hct降低,差異有統(tǒng)計學意義(P0.05)。4.兩組患者在T1、T3時間點的Alb、Scr、Ccr組內比較差異無統(tǒng)計學意義(均P0.05)。5.與R組相比L組術后心血管系統(tǒng),呼吸系統(tǒng)并發(fā)癥,術后感染,術后譫妄發(fā)生率多于R組,但與R組對比兩組比較差異無統(tǒng)計學意義(P0.05)。6.與R組相比,L組患者在術后消化系統(tǒng)并發(fā)癥例數(shù),術后總并發(fā)癥例數(shù)及術后發(fā)生并發(fā)癥人數(shù)上多于R組,兩組之間的差異有統(tǒng)計學意義(P0.05)。7.兩組比較術后下床活動時間、拔尿管時間、住院天數(shù)之間的差異無統(tǒng)計學意義(P0.05)。與R組比較術后首次排氣時間、首次排便時間、進食固體時間,L組多于R組,兩組間的差異有統(tǒng)計學意義(P0.05)。結論:限制性輸液能減少術后胃腸道的并發(fā)癥,及減少總的術后并發(fā)癥,并加快術后胃腸功能的恢復。
[Abstract]:Objective: To investigate the effect of restrictive infusion on postoperative complications of laparoscopic colon cancer resection. Methods: 80 patients, aged 35~70, Body mass index (BMI) 18~30Kg/m2, ASA grade I ~ II, were selected to be divided into 2 groups by random digital table, and the patients were divided into 2 groups. Infusion group (group R) and non restrictive infusion group (group L), limited infusion group: before anesthesia induction to operation end, 6ml/ (Kg.h), monitoring central venous pressure (CVP), and maintaining CVP in 5~8cmH2o. non restrictive infusion group: total amount of infusion liquid = compensatory capacity + physiological needs + cumulative loss + continued loss + third gap loss Two groups of crystal and colloid ratio were 2: 1. two groups before anesthesia (T1), 1 hours after operation (T2), postoperative 24h (T3) detection of arterial blood gas analysis index; 24h before operation 24h, postoperative 24h detection of liver function, renal function, postoperative complications were observed. Results: 1. two groups of patients in the general situation and operation time difference was not statistically significant (P0. 05) there was no significant difference in the time of operation, the time of extubation, the amount of bleeding and the amount of urine in the.2. two groups (P0.05).3. two groups, and there was no statistical difference between the PO2, PCO2, BE, Hb in the time points of T1, T2, and T3. T2 and T3 Hct decreased, the difference was statistically significant (P0.05) in.4. two groups of patients in T1, T3 point Alb, Scr, Ccr group, there was no statistical difference (P0.05).5. and compared with the group of postoperative cardiovascular system, respiratory complications, postoperative infection, postoperative delirium incidence rate more than those in the group, but compared with the group comparison of the difference was no difference. Statistically significant (P0.05).6. compared with the R group, the number of postoperative complications in the L group, the number of postoperative complications and the number of postoperative complications were more than those in the R group. There was a significant difference between the two groups (P0.05) the group of.7. two had no statistical difference between the time of removal of the ureter and the days of hospitalization. P0.05. Compared with group R, the first exhaust time after operation, the first defecation time, feeding solid time, L group more than group R, the difference between the two groups was statistically significant (P0.05). Conclusion: restrictive infusion can reduce the complications of postoperative gastrointestinal tract, reduce the total postoperative complications, and accelerate the recovery of postoperative gastrointestinal function.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614;R735.35

【參考文獻】

相關期刊論文 前6條

1 李炎;蔡暢;陳小非;漆勇;潘志浩;;限制性液體管理與保護性通氣策略聯(lián)合應用對肺切除患者術后肺功能的影響[J];現(xiàn)代實用醫(yī)學;2016年02期

2 孟杰;陳麗;肖航;;術中限制性輸液對老年患者結腸癌術后呼吸機相關肺炎的影響[J];實用醫(yī)學雜志;2015年17期

3 江朝秀;劉敬臣;倪玉霞;彭鐫寶;;限制性輸液應用于老年開腹手術對血液流變學和S100B蛋白的影響[J];廣西醫(yī)科大學學報;2013年02期

4 王瑜;王燕婷;蔣彥彥;林亞華;鄒忠東;;腹腔鏡結直腸癌根治術CO_2氣腹對下肢深靜脈血流動力學影響的研究[J];中國實用外科雜志;2009年07期

5 初啟江,高勝海,徐建利,馬端蘭,劉愛蓓,李瑞英;~(99m)Tc-DTPA清除率、肌酐清除率及彩色多普勒在評價腎功能中的價值比較[J];中國綜合臨床;2005年08期

6 沈賢,霍正祿;嚴重多發(fā)傷早期液體輸入量的探討[J];中國急救醫(yī)學;2003年06期

，

本文編號：1918030