肝癌半肝切除围手术期液体治疗对术后恢复的影响

目的探讨肝细胞肝癌半肝切除术中、术后液体治疗对术后胸腔积液及术后恢复的影响。方法分析肝癌半肝切除术病例46例,比较术后早期有、无胸腔积液,组间术中、术后前3 d液体治疗等变量12项,筛选出影响术后早期发生胸腔积液的一些变量,并进一步分析这些变量与术后早期恢复的关系。结果术中入液量>55 ml/kg、术中入出量差>50 ml/kg、术后第1d入液量>70 ml/kg、术后第2 d、第3 d入液量>60 ml/kg和未实现术后前3 d内至少有1 d液体平衡≤-8 ml/kg的组术后易发生胸腔积液,术后住ICU时间长,肛门排气时间晚,术后腹水量多。结论在其他因素相对恒定的情况下,合理控制肝癌半肝切除术中和术后前3 d入液量,术后早期在血液动力学稳定的前提下,早期实现适量的液体负平衡,有利于促进患者术后早期恢复。

Effect of peri-operative fluid therapy influencing recovery after hemihepatectomy of hepatocellular carcinoma

Objective To investigate the effect of fluid therapy in intra-operative and post-operative and postoperative recovery and pleural effusion for patients with hepatocellular carcinoma after hemihepatectomy. Method The Clinical data of 46 patients with hepatocellular carcinoma after hemihepatectomy were analyzed.Twelve variables,such as intra-operative and post-operative fluid therapy were analyzed and compared between the pleural effusion group and the none-pleural effusion group,and analyze variables affecting postoperative early recovery.Result The intra-operative intravenous fluid intake was more than 55ml/kg,the intra-operative fluid out of margin was more than 50ml/kg,the intravenous fluid intake more than 70ml/kg of the first day of postoperative and more than 60ml/kg on the second day and the third day of postoperative,realization fluid balance more than-8ml/kg,at least 1or 2 days of the first 3 days of postoperation had a high incidence of pleural effusion,longer time staying in ICU and shorter time of Exhaust.and larger ascite.Conclusion It is important to control strictly the amount of transfusion in the intra-operative period and the first 3 days of postoperative in the peri-operative fluid therapy,and early appropriate negative fluid balance would be helpful to promote the early recovery of the patients after operation.