乳酸林格氏液体和羟乙基淀粉130/0.4氯化钠注射液对腹腔镜下胃肠癌根治术术后结局的影响

Effect of Intraoperative Ringer’s Lactate and Hydroxyethyl Starch 130/0.4 and Sodium Chloride Injection on Outcomes After Laparoscopic Gastrointestinal Carcinoma Radical Prostatectomy

关键词:  乳酸林格氏液  羟乙基淀粉130/0.4氯化钠注射液  肠蠕动恢复时间  进食恢复时间  术后住院时间

Key words:  ringer’s lactate solution  hydroxyethyl starch 130/0.4 and sodium chloride injection  recovery time of intestinal peristalsis  recovery eating time  length of hospital stay

摘要:

目的 探讨术中输入乳酸林格氏液体和羟乙基淀粉130/0.4氯化钠注射液对腹腔镜下胃肠癌根治术患者术后结局的影响。方法 本研究为随机、双盲前瞻性研究。选择2011年7月—2013年3月择期胃肠外科肿瘤大手术患者88例，美国麻醉医生分级(ASA)Ⅰ~Ⅱ，随机分成4组：Ⅰ组(乳酸林格氏液负荷和维持)，Ⅱ组(羟乙基淀粉130/0.4氯化钠注射液负荷，乳酸林格氏液维持)，Ⅲ组(羟乙基淀粉130/0.4氯化钠注射液负荷和维持)，Ⅳ组(预注乳酸林格氏液体，羟乙基淀粉130/0.4氯化钠注射液负荷，乳酸林格氏液体维持)；负荷治疗以9 mL·kg^-1羟乙基淀粉130/0.4氯化钠注射液或者乳酸林格氏液，再以12 mL·kg^-1羟乙基淀粉130/0.4氯化钠注射液或者乳酸林格氏液体输注1 h，之后液体治疗根据麻醉医师判断，将心搏出量变异(SVV)值维持在13%左右。术后观察包括术后胃肠功能恢复时间、并发症以及术后住院时间。结果 输液顺序不影响术后结局。术中输入乳酸林格氏液体≥2 L以及并发症影响术后肠蠕动恢复时间和进食恢复时间(双因素ANOVA，P=0.020)，但是只有术后并发症延长术后住院时间(P=0.001)。术中输入乳酸林格氏液和并发症作为独立因素均延长进食恢复时间达2 d。术中输入>1 L的羟乙基淀粉130/0.4氯化钠注射液对术后胃肠功能恢复无影响，而且维持术中尿液分泌优于乳酸林格氏液。结论 术中输入乳酸林格氏液延长腹腔镜下胃肠癌术后的胃肠功能恢复时间，而羟乙基淀粉130/0.4氯化钠注射液不影响术后胃肠功能恢复；只有并发症延长住院时间。

Abstract:

OBJECTIVE To evaluate the intraoperative infusion of Ringer’s lactate and hydroxyethyl starch 130/0.4 and sodium chloride injection on the outcomes after laparoscopic gastrointestinal carcinoma radical prostatectomy. METHODS This was a prospective randomized double-blinded study. Eighty-eight patients with American Society of Anesthesiologist physical status Ⅰ-Ⅱ scheduled for major abdominal cancer surgery were randomized into 4 groups: group Ⅰ(bolus with Ringer’s lactate, continues with Ringer’s lactate), group Ⅱ(bolus with hydroxyethyl starch 130/0.4 and sodium chloride injection, continuous with Ringer’s lactate), group Ⅲ(bolus with hydroxyethyl starch 130/0.4 and sodium chloride injection, continuous with hydroxyethyl starch 130/0.4 and sodium chloride injection), groups Ⅳ(preloading with Ringer’s lactate, bolus with starch, continuous with Ringer’s lactate). Bolus fluid treatment was with 9 mL·kg^-1 either hydroxyethyl starch 130/0.4 and sodium chloride injection or Ringer’s lactate, followed by a continuous infusion with 12 mL·kg^-1 of either hydroxyethyl starch 130/0.4 and sodium chloride injection or Ringer’s lactate over 1 h. Further fluid therapy was managed at the discretion of the attending anesthesiologist maintaining stroke volume variance (SVV) value within 13%. Outcome data consisted of postoperative gastrointestinal recovery time, complications and length of hospital stay. RESULTS The order of the infusions had no impact on the outcome. Both the administration of ≥2 L of Ringer’s lactate and the development of a surgical complication were associated with a longer recovery time of intestinal peristalsis and recovery eating time (two-way ANOVA, P=0.020), but only surgical complications prolonged the length of hospital stay(P=0.001). The independent effect of Ringer’s lactate and complications on recovery eating time amounted to 2 days each. The infusion of ≥1 L of hydroxyethyl starch 130/0.4 and sodium chloride injection did not adversely affect gastrointestinal recovery and maintained urinary excretion better than Ringer’s lactate. CONCLUSION Ringer’s lactate but not hydroxyethyl starch 130/0.4 and sodium chloride injection prolongs the gastrointestinal recovery time in patients undergoing laparoscopic gastrointestinal cancer surgery. Only the development of surgical complications prolong the length of hospital stay.