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| 目标导向液体治疗中晶体液和胶体液对血管内皮多糖包被的影响 |
| Effect of crystalloid or colloid for goal-directed fluid therapy on the endothelial glycocalyx |
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| DOI：10.12089/jca.2018.09.010 |
| 中文关键词: 目标导向液体治疗 晶体液 胶体液 腹部手术 多糖包被 |
| 英文关键词: Goal-directed fluid therapy Crystalloid Colloid Abdominal surgery Endothelialglycocalyx |
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| 中文摘要: |
目的 探讨在相同目标导向液体治疗(GDFT)策略下, 晶体液和胶体液对血管内皮多糖包被的影响。
方法 选取拟于我院行择期腹膜后肿瘤切除手术的患者80例,男50例，女30例，ASA Ⅰ或Ⅱ级，依据随机数字表法分为晶体液组和胶体液组，每组40例。两组患者均以1.5 ml·kg-1·h-1连续输注复方乳酸钠以维持基础补液量, 连接FloTrac/Vigileo系统监测每搏量变异度(SVV)和心脏指数(CI), 并将SVV≤12％、CI≥2.5 L·min-1·m-2和MAP≥60 mmHg作为目标进行GDFT, 晶体液组液体冲击采用复方乳酸钠, 胶体液组液体冲击采用羟乙基淀粉130/0.4氯化钠注射液。记录入室、手术开始1、4 h、术后24、72 h的血清多糖包被降解产物蛋白聚糖-1(SCD-1)、透明质酸(HA)和硫酸乙酰肝素(HS)的浓度；记录术中输液总量和术后恶心呕吐(PONV)、切口感染、肺部并发症和急性肾损伤(AKI)等发生情况。
结果 与入室比较, 两组血清多糖包被降解产物在手术开始1、4 h、术后24、72 h均呈不同程度增加, 手术开始4 h升至最高, 且于术后逐渐回落, 但术后72 h仍高于入室;术后24、72 h, 胶体液组血清多糖包被降解产物明显高于晶体液组(P<0.05)。胶体液组术中输液总量明显少于晶体液组(P<0.05)。两组患者PONV、切口感染、肺部并发症和AKI发生率差异无统计学意义。
结论 在相同液体管理策略下, 胶体液虽然可以在一定程度上减少液体输注量, 但也会对血管内皮多糖包被产生更加持久和严重的破坏。 |
| 英文摘要: |
Ojective To investigate the capacity effect of crystalloid and colloidal fluid in large abdominal surgery under the same goal-directed fluid therapy (GDFT) strategy and the effect of both on vascular endothelial glycocalyx.
Methods Eighty patients undergoing elective resection of peritoneum tumors in our hospital, 50 males and 30 females, falling into ASA physical status Ⅰ or Ⅱ, were divided into crystalloid group (n=40) and colloid group (n = 40) based on random number table. Continuous infusion of sodium lactate Ringer at 1.5 ml·kg-1·h-1was used to maintain baseline volume in both groups. Stroke volume variation (SVV) and cardiac index (CI) were monitored with FloTrac/Vigileo system. GDFT was performed targeting SVV ≤ 12％, CI ≥ 2.5 L·min-1·m-2 and mean arterial pressure (MAP) ≥ 60 mmHg. The fluid load of the crystalloid group and the colloid group were sodium lactate ringer and hydroxyethyl starch 130/0.4, respectively. Serum proteoglycan-1 (SCD-1), hyaluronic acid (HA) and heparan sulfate (HS) at the time to operation room, 1 h at the beginning of operation, 4 h after operation, 24 h after operation and 72 h after operation were recorded. And the incidence of complications such as postoperative nausea and vomiting (PONV), wound infection, pulmonary complications, and acute kidney injury (AKI) were also recorded.
Results The levels of serum polysaccharide in the two groups increased along with the time. At 4 h after operation, they increased to the peak and gradually decreased after operation, but remained above the baseline level 72 h after operation. And 24 h after operation and 72 h after operation, the levels of serum polysaccharide of the colloid group were higher than that in the crystalloid group, the difference was statistically significant (P < 0.05). There were no significant differences in the incidence of PONV, wound infection, pulmonary complications, and AKI.
Conclusion Under the same fluid management strategy, colloid can reduce fluid infusion to a certain degree, it will also cause more permanent and severe damage to the vascular endothelialglycocalyx. |
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