| 周立民,王彩霞,李国华,任 杰,李 俊,张文生.目标导向液体管理策略对脑肿瘤切除术患者血乳酸水平、血流动力学及认知功能的影响[J].,2021,(20):3927-3931 |
| 目标导向液体管理策略对脑肿瘤切除术患者血乳酸水平、血流动力学及认知功能的影响 |
| Effects of Goal-directed Fluid Management Strategy on Blood Lactate Level, Hemodynamics and Cognitive Function in Patients Undergoing Brain Tumor Resection |
| 投稿时间：2021-03-28 修订日期：2021-04-23 |
| DOI：10.13241/j.cnki.pmb.2021.20.025 |
| 中文关键词: 目标导向液体管理 脑肿瘤 乳酸 血流动力学 认知功能 |
| 英文关键词: Target directed fluid management Brain tumor Lactate Hemodynamics Cognitive function |
| 基金项目:山东省医药卫生科技发展计划项目（2017WS638）；泰安市科技创新发展项目（2020NS111） |
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| 中文摘要: |
| 摘要 目的：探讨目标导向液体管理策略对脑肿瘤切除术患者血乳酸水平、血流动力学及认知功能的影响。方法：选择2016年1月至2019年10月于山东第一医科大学第二附属医院行脑肿瘤切除术的患者110例，以随机数字表法分为对照组和研究组，每组55例，对照组患者接受常规输液管理，研究组患者接受目标导向液体管理，观察两组患者晶体液用量、胶体液用量、输液总量、失血量、尿量情况，对比两组麻醉诱导前（T0）、气管插管即刻（T1）、切开硬脑膜即刻（T2）和手术结束时（T3）动脉乳酸（aLac）、静脉乳酸（vLac）、动静脉乳酸差值（△Lac）、脑乳酸生成率（Lac PR）、血流动力学水平以及两组患者术前、术后1 d、术后3 d、术后7 d 简易智力状态量表（MMSE）评分。结果：研究组胶体液用量、输液总量及尿量显著高于对照组（P<0.05）。T1、T2、T3时间点研究组aLac、vLac、△Lac、Lac PR显著低于对照组（P＜0.05）。T3时间点研究组心脏指数（CI）、平均动脉压（MAP）、动脉血氧含量（CaO2）显著高于对照组（P＜0.05）。术后1 d、术后3 d、术后7 d研究组MMSE评分显著高于对照组（P＜0.05）。结论：目标导向液体管理策略能够降低脑肿瘤切除术患者术后血液中乳酸水平，改善患者血流动力学，减轻手术及麻醉对患者认知功能的影响。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effect of goal-directed fluid management strategy on blood lactate level, hemodynamics and cognitive function in patients undergoing brain tumor resection. Methods: 110 patients who underwent brain tumor resection in The Second Affiliated Hospital of Shandong First Medical University from January 2016 to October 2019 were selected, they were randomly divided into two groups: study group and control group, 55 patients in each group. The patients in the study group received the goal-directed fluid management, while the patients in the control group received the routine infusion management. The amount of crystal fluid, colloid fluid, total amount of infusion, blood loss and urine volume of the two groups were observed. Arterial lactate (aLac), venous lactate (vLac), arteriovenous lactate difference (△Lac), brain lactate production rate (Lac PR) and hemodynamic level were observed before anesthesia induction (T0), at the time of endotracheal intubation (T1), at the time of dural incision (T2) and at the end of operation (T3). The results of MMSE were compared between the two groups before operation, one day after operation, three days after operation and seven days after operation. Results: The dosage of colloid solution, total amount of infusion and urine volume in the study group were significantly higher than those in the control group(P<0.05). The aLac, vLac, △Lac, Lac PR in T1, T2 and T3 time points of the study group were significantly lower than those in the control group(P< 0.05). The cardiac index(CI), mean arterial pressure(MAP) and arterial oxygen content(CaO2) of the T3 time point study group were significantly higher than those of the control group, and MMSE score of the study group was significantly higher than that of the control group 1d, 3d and 7d after surgery(P<0.05). Conclusion: Target directed fluid management can reduce the blood lactate level, improve the hemodynamics, and reduce the influence of surgery and anesthesia on the cognitive function of patients. |
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