腹部手术患者围手术期水电解质紊乱观察研究

发布时间：2018-07-20 19:58

【摘要】：目的：分析胃癌根治术、结直肠癌手术、全子宫切除术患者麻醉诱导前后电解质紊乱发生的情况。方法：选择广西医科大学第一附属医院2013-2015年实施胃癌根治术、结直肠癌手术、全子宫切除术患者各150例,收集患者的临床资料。分别作为胃癌根治组(G组)、结直肠癌组(C组)和全宫切组(H组),于术前24h(To)、麻醉诱导前30min(T1)、麻醉诱导后1h(T2)、麻醉诱导后2h(T3)、手术结束时(T4)监测血各项电解质浓度、平均动脉压(MAP)及心率(HR)。术中液体按米勒麻醉学(Miller's Anesthesiology)第六版输液方案进行管理。观察记录各组患者麻醉时长、手术时长、输入液体类型及剂量、出血量以及尿量。数据采用SPSS 16.0统计软件分析,计量资料以均数±标准差(x±s)表示,组内比较采用t检验,组间比较采用单因素方差分析,两两比较采用SNK法；计数资料采用RxC表χ2检验。P0.05为差异有统计学意义。结果：三组患者的麻醉时长、手术时长、尿量、出血量、总液体输入量等差异无统计学意义。各组患者各时间点电解质紊乱发生情况：在麻醉诱导前30min(T1),三组患者的低钾血症发生率相比术前24h(T0)均升高(P0.05),结直肠癌手术患者的低钙血症发生率相比术前24h(T0)升高。三组患者麻醉诱导前30min(T1)电解质紊乱发生情况：三组患者麻醉诱导前30min(T1)电解质紊乱情况比较：胃癌根治术患者的低钾血症发生率高于其他两组手术患者(P0.05),平均血清钾浓度较术前24h(T0)降低(P0.05),且低于其他两组手术患者血清钾浓度(P0.05)；结直肠癌手术患者低钙血症发生率高于其他两组手术患者(P0.05)；胃癌根治术患者麻醉诱导前30min(T1)患者性别、年龄、ASA分级、体重指数、术前是否出现低钾血症组内比较差异无统计学意义(P0.05)。结论：腹部手术患者麻醉诱导前均较容易发生水电解质紊乱。最常见水电解质紊乱类型为低钾血症,次为低钙血症。其中胃癌根治术患者的低钾血症发生情况最为严重其,而结直肠癌手术患者低钙血症较为突出。
[Abstract]:Objective: to analyze the occurrence of electrolyte disorder before and after anesthesia induction in patients with gastric cancer radical resection, colorectal cancer surgery and total hysterectomy. Methods: the first affiliated Hospital of Guangxi Medical University was selected from 2013 to 2015 to carry out radical gastrectomy, colorectal cancer surgery and total hysterectomy. The clinical data of the patients were collected. They were treated as radical gastrectomy group (G group), colorectal cancer group (C group) and total uterine resection group (H group), respectively, 24 hours before operation (to), before anesthesia induction (T1), 1 hour after anesthesia induction (T2), 2 hours after anesthesia induction (T3), and at the end of operation (T4) to monitor serum electrolyte concentration, mean arterial pressure (map) and heart rate (HR). Intraoperative fluid was administered according to the sixth edition of Hans Muller Anesthesiology (Milleros Anesthesiology). The duration of anesthesia, the duration of operation, the type and dosage of infusion fluid, the amount of blood loss and urine volume were observed and recorded. The data were analyzed by SPSS 16.0 software, and measured data were expressed as mean 卤standard deviation (x 卤s). The intra-group comparison was performed by t test, the inter-group comparison by single-factor ANOVA, and the comparison between two groups by SNK method. The count data were statistically significant by 蠂 2 test of RxC table. Results: there was no significant difference in anesthetic duration, operation time, urine volume, blood loss and total fluid input among the three groups. Before anesthesia induction, the incidence of hypokalemia in the three groups was higher than that in 24 hours before operation (P0.05), and the incidence of hypocalcemia in patients with colorectal cancer surgery was higher than that in preoperative 24 hours (T0). 30min (T1) electrolyte Disorder before Anesthesia Induction: comparison of 30min (T1) electrolyte Disorder before Anesthesia Induction: the incidence of hypokalemia in patients with radical gastrectomy was higher than that in the other two groups (P0.05), the average serum level was higher than that in the other two groups (P0.05). The concentration of potassium was lower than that of 24 hours before operation (P0.05), and lower than that of the other two groups (P0.05). The incidence of hypocalcemia in patients with colorectal cancer was higher than that in the other two groups (P0.05), the sex, age and body mass index (BMI) of patients with 30min (T1) before anesthesia induction in patients with gastric cancer were significantly higher than those in the other two groups (P0.05). There was no significant difference in preoperative hypokalemia (P0.05). Conclusion: water and electrolyte disorders are easy to occur in patients undergoing abdominal surgery before anesthesia induction. The most common type of water-electrolyte disorder was hypokalemia, followed by hypocalcemia. The incidence of hypokalemia in patients with radical gastrectomy is the most serious, while hypocalcemia in patients with colorectal cancer is more prominent.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R614

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