肝癌患者肝叶切除术后液体治疗

目的 对肝癌切除术后不同液体治疗方案进行比较,探寻合理的液体治疗方案以降低肝切除围手术期容量风险.方法 80例肝切除术后肝癌患者根据补液方法不同分为4组,各组均于术后第1天输注：A组给予等渗晶体液输注,间断给予利尿剂（速尿20～100 mg/d）;B组给予等渗晶体液与羟乙基淀粉（130/0.4）以2∶1比例输注,间断给予利尿剂（速尿20～100mg/d）;C组给予7.5％ NaCl溶液（4 mL/kg）快速输注,继续给予等渗晶体液与羟乙基淀粉（130/0.4）以2∶1比例输注,间断给予利尿剂（速尿20～100mg/d）;D组给予等渗晶体液与羟乙基淀粉（130/0.4）以2∶1比例输注,给予利尿合剂（速尿20 mg,多巴胺80～120mg） 24 h持续微泵给药.对患者术后输液量、尿量、液体平衡量、肝肾功能电解质、肠道排气时间、腹水消退时间和住院时间进行监测.结果 各组患者手术时间、术中失血量和术中输液量无显著差异.B组与A组相比术后液体正平衡量和血清乳酸盐水平显著降低;C组与A组相比术后液体正平衡量和血清乳酸盐水平同样显著降低;D组与B、C组相比术后液体正平衡量和血清乳酸盐水平明显降低.B、C、D组术后1、4、7d肝功能恢复显著优于A组;D组术后肠道排气时间、腹水消退时间、术后住院时间比A组显著缩短.结论 肝切除术后给予羟乙基淀粉和小剂量高渗盐水能较好地维持有效循环容量,减少液体正平衡,改善组织灌注.速尿与血管活性药物构成利尿合剂以持续静脉微泵给药的方式能减少肝切除术后腹水的产生并促其快速消退,避免了大量腹水引流或腹水溢漏引起严重的蛋白质丢失和电解质紊乱.

Fluid therapy after hepatic resection for hepatocellular carcinoma patients

Objective Reasonable fluid therapy to reduce the perioperative capacity risk through compare liquid treatment after hepatic resection was explored.Methods Eighty patients with hepatocellular carcinoma after hepatectomy were divided into four groups.Group A only received isotonic crystalloid fluid,intermittent diuretics （20-100 mg/d）.Group B were given isotonic crystalloid solution and hydroxyethyl starch （130/0.4） in 2 ∶ 1 ratio,intermittent diuretics （20-100 mg/d）.Group C received 7.5％NaCl （4 mL/kg） rapid infusion after first postoperative day,following isotonic crystalloid solution and hydroxyethyl starch （130/0.4） in 2 ∶ 1 ratio,intermittent diuretics （20-100 mg/d）.Group D were given isotonic crystalloid solution and hydroxyethyl starch （130/0.4） in 2 ∶ 1 ratio,and they were given diuretic agents （furosemide 20 mg dopamine 80-120 mg） micro-pump administration with 24 h.Results The mean operative time,intraoperative blood loss and transfusion volume had no significant difference.Group B＇s,C＇s and D＇s positive fluid balance volume and serum lactate levels were significantly lower than in group A,however,liver function recovery after 1,4,7 days was significantly better in group A.Group C＇s and D＇s postoperative intestinal exhaust time,ascites subsided time and in hospital stay were significantly shorter than for group A.Conclusion Small dose of hypertonic saline and hydroxyethyl starch can be better in maintaining an effective circulating volume,reducing the positive fluid balance and improving tissue perfusion.Diuretics and vasoactive drugs micro pump continuous administration can increase the urine output,reduce tissue edema and promote the recovery of organ function,and they can also reduce ascites production and promote its subsided after liver resection.