限制性输液在腹腔镜下结肠癌切除手术中的应用

发布时间：2018-05-21 06:00

本文选题：限制性输液 + 结肠癌切除术　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨限制性输液对腹腔镜下结肠癌切除术患者术后相关并发症的影响。方法:选取择期拟在全麻下行结肠癌切除术的患者80例,年龄35~70岁,体重指数(Body mass index,BMI)18~30Kg/m2,ASA分级Ⅰ~Ⅱ级,采用随机数字表法,将患者分为2组:限制输液组(R组)和非限制输液组(L组),限制性输液组:麻醉诱导前至手术结束,与输液速度为6ml/(Kg.h),监测中心静脉压(CVP),维持CVP在5~8cmH2o。非限制性输液组:输注液体总量=补偿性扩容量+生理需要量+累计缺失量+继续损失量+第三间隙缺失量。两组晶,胶体比均为2∶1。两组均在麻醉前(T1)、手术开始后1小时(T2)、术后24h(T3)检测患者动脉血气分析指标;于手术前24h,术后24h检测肝功能、肾功能;观察术后并发症的情况。结果:1.两组患者在一般情况及手术时间的差异无统计学意义(P0.05)。2.两组患者在手术时间、拔管时间、术中出血量及尿量的差异无统计学意义(P0.05)。3.两组患者,在T1、T2、T3时间点的PO2、PCO2、BE、Hb比较,差异无统计学意义(P0.05)。与R组比L组在T2及T3时间点的Hct降低,差异有统计学意义(P0.05),同组患者与T1时间点比较,T2及T3的Hct降低,差异有统计学意义(P0.05)。4.两组患者在T1、T3时间点的Alb、Scr、Ccr组内比较差异无统计学意义(均P0.05)。5.与R组相比L组术后心血管系统,呼吸系统并发症,术后感染,术后谵妄发生率多于R组,但与R组对比两组比较差异无统计学意义(P0.05)。6.与R组相比,L组患者在术后消化系统并发症例数,术后总并发症例数及术后发生并发症人数上多于R组,两组之间的差异有统计学意义(P0.05)。7.两组比较术后下床活动时间、拔尿管时间、住院天数之间的差异无统计学意义(P0.05)。与R组比较术后首次排气时间、首次排便时间、进食固体时间,L组多于R组,两组间的差异有统计学意义(P0.05)。结论:限制性输液能减少术后胃肠道的并发症,及减少总的术后并发症,并加快术后胃肠功能的恢复。
[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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.35

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