不同液体治疗策略对甲状腺癌手术患者机体内环境的影响

发布时间：2018-05-10 23:40

本文选题：液体治疗 + 血流动力学　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：目前液体治疗仍存在争议。本研究通过观察几种不同性质的液体治疗策略对甲状腺癌手术患者术中机体内环境的影响。观察术中患者内环境的变化，，为液体治疗策略提供一定的临床依据。方法：选择40名ASA分级I-II级拟择期进行甲状腺癌手术的患者，年龄在30-60岁之间，预计手术时间在2.5-5小时，随机分为A、B、C、D四组。所有患者在入手术室之前进行常规的术前准备。入手术室后进行持续的心电（ECG）、心率（HR）、血压(BP)、血氧饱和度（SpO2）监测。所有患者进行常规全凭静脉麻醉方法麻醉。患者在开放通路后，按10ml/kg·h的速度输入醋酸钠林格注射液。30min后进行麻醉诱导，诱导结束后，A组以20ml/kg·h输入醋酸钠林格注射液，B组C组D组以同样的速度输入羟乙基淀粉130/0.4氯化钠注射液，输入30min。30min后手术开始，此时A组B组更换为0.9%氯化钠注射液C组更换为转化糖注射液D组更换为醋酸钠林格注射液，四组均已10ml/kg·h的速度输入。60min后A、B、C、D四组均更换为0.9%氯化钠溶液以10ml/kg·h输入速度至手术结束。本研究将麻醉诱导即刻设为T1，手术开始前即刻设为T2，手术开始60min设为T3，术终设为T4。在T1-T4四个时间点分别记录HR、BP、ECG、SpO2，并采集动脉血2ml进行血气分析和血糖测定。结果：40名患者均顺利完成本研究。在血流动力学方面：四组患者在T1时刻BP及HR无明显差异（P＞0.05）无统计学意义。在T2-T4各时间点A组与其它组相比较BP低于基础值（P＜0.05）有统计学意义。四组患者在T2时间点HR均降低（P＜0.05）。HCT比较，在T2时间点各组HCT均降低与T1比较有统计学意义(P＜0.05)。T3-T4段A组HCT恢复至麻醉前水平（P＞0.05），B、C、D三组HCT仍保持在较低水平（P＜0.05）。在T1、T2时刻四组比较无明显差异（P＞0.05），T3、T4时刻A组HCT高于其它三组(P＜0.05)。电解质及血糖方面：Na+比较，C组在T3、T4时间点Na+低于基础水平（P＜0.05），组间比较C组低于A、B、D三组（P＜0.05）；K+比较，B、D组K+在T2—T4段低于基础水平（P＜0.05），C组在T+2时间点K降低（P＜0.05），T3时间点之后恢复到基础水平（P＞0.05）；Ca2+比较，B、C、D三组在T2-T2+4段Ca均低于基础水平（P＜0.05），A组无明显变化（P＞0.05）；血糖比较，C组在T3-T4段血糖高于基础值（P＜0.05），其它三组无明显变化（P＞0.05）。酸碱平衡方面：PH比较：A组在T3-T4段PH值降低（P＜0.05）有统计学意义，B、C、D三组在T2-T4段PH值降低（P＜0.05）；SB比较，A组在T2-T4段SB高于其它组（P＜0.05）；BE比较，A组在T2-T3段BE值高于其它三组（P＜0.05），T1、T4时间点无明显差异（P＞0.05）。结论： 1.醋酸钠林格氏液成分接近人体内环境电解质和PH值，能维持术中患者机体内环境的稳定； 2.转化糖能够为患者提供能量并能补充K+浓度但会对血糖造成影响； 3.羟乙基淀粉130/0.4氯化钠能维持患者术中血流动力学的稳定，但会引起血液的稀释，造成K+、Ca2+稀释性降低。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R736.1

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