切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2013, Vol. 07 ›› Issue (05) : 354 -357. doi: 10.3877/cma.j.issn.1674-0793.2013.05.006

所属专题: 文献

论著

限制性液体治疗对老年患者围手术期醛固酮水平的影响
张娟娟1, 虞文魁1,(), 石佳靓1, 高涛1, 习丰产1, 朱维铭1, 李宁1   
  1. 1. 210002 南京军区南京总医院全军普通外科研究所
  • 收稿日期:2013-07-09 出版日期:2013-10-01
  • 通信作者: 虞文魁

Effects of fluid restriction on perioperative plasma aldosterone for the aged patients

Juan-juan ZHANG1, Wen-kui YU1,(), Jia-liang SHI1, Tao GAO1, Feng-chan XI1, Wei-ming ZHU1, Ning LI1   

  1. 1. Department of Surgery, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
  • Received:2013-07-09 Published:2013-10-01
  • Corresponding author: Wen-kui YU
  • About author:
    Corresponding author: YU Wen-kui, Email:
引用本文:

张娟娟, 虞文魁, 石佳靓, 高涛, 习丰产, 朱维铭, 李宁. 限制性液体治疗对老年患者围手术期醛固酮水平的影响[J/OL]. 中华普通外科学文献(电子版), 2013, 07(05): 354-357.

Juan-juan ZHANG, Wen-kui YU, Jia-liang SHI, Tao GAO, Feng-chan XI, Wei-ming ZHU, Ning LI. Effects of fluid restriction on perioperative plasma aldosterone for the aged patients[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2013, 07(05): 354-357.

目的

限制性液体治疗能减少老年患者术后并发症,改善预后。本文主要观察限制性液体治疗对老年患者围手术期血浆醛固酮水平的影响。

方法

将2012年6月至10月收治的胃肠肿瘤手术患者分为两组,分别为老年组(年龄≥65岁,40例)和非老年组(年龄<65岁,40例),围手术期液体治疗采用限制性液体治疗方案,监测两组术前(D0)、术后第1天(D1)、术后第2天(D2)、术后第3天(D3)的血浆醛固酮水平,并记录术后3d生命体征、动脉血乳酸水平、每小时液体入量和尿量。

结果

两组术后3d的动脉血乳酸、每小时液体入量和尿量差异无统计学意义。术前老年组醛固酮水平明显低于非老年组,t=2.164,P=0.034。两组术后醛固酮均先升高后降低,术后第2天最高,老年组术后醛固酮水平高于非老年组,其中术后第1天差异有统计学意义,t=-2.300,P=0.024。

结论

老年患者术前醛固酮水平明显低于非老年患者,而在术后醛固酮水平高于非老年患者,尤其是术后第1天差异较明显。

Objective

To investigate the effects of fluid restriction on perioperative plasma aldosterone for the aged patients.

Methods

Patients with gastrointestinal neoplasms from June to October 2012 were divided into two groups, the aged group(≥65 years old, 40 cases) and the non-aged group(<65 years old, 40cases). They received fluid restriction therapy during perioperative period. To observe plasma aldosterone on the day before operation, the first day, the second day and the third day after operation, and postoperative vital sign, such terms as arterial blood lactic acid, fluid volume and urinary volume per hour in the two groups were recorded.

Results

There were no differences of arterial blood lactic acid, fluid volume and urinary volume per hour in the two groups. The plasma aldosterone was significantly lower in the aged group before operation, t=2.164, P=0.034. The postoperative plasma aldosterone was increased, and reached peak on the second day after operation. The postoperative plasma aldosterone was higher in the aged group, and there was significant difference on the first day after operation, t=-2.300, P=0.024.

Conclusion

Compared to the non-aged group, the plasma aldosterone of the aged group is significantly lower before operation, and higher after operation, especially the first day after operation.

表1 两组患者一般情况的比较
表2 两组患者术后3d的血乳酸、每小时液体入量和尿量的比较(±s)
表3 两组患者围手术期血浆醛固酮水平的比较(nmol/L,±s)
1
Rodrigo Casanova MP, García Peña JM, Lomillos Rafols V, et al. Perioperative fluid therapy. Rev Esp Anestesiol Reanim, 2010, 57(9): 575-585.
2
Allison SP, Lobo DN. Fluid and electrolytes in the elderly. Curr Opin Clin Nutr Metab Care, 2004, 7(1): 27-33.
3
Gao T, Li N, Zhang JJ, Xi FC, et al. Restricted intravenous fluid regimen reduces the rate of postoperative complications and alters immunological activity of elderly patients operated for abdominal cancer: a randomized prospective clinical trail. World J Surg, 2012, 36(5): 993-1002.
4
俞瑞东,陆小川,宋晓华, 等. 围手术期限制性液体治疗对老年病人术后并发症和预后的影响. 中国实用外科杂志, 2012, 32(10): 853-855.
5
Luckey AE, Parsa CJ. Fluid and electrolytes in the aged. Arch Surg, 2003, 138(10): 1055-1060.
6
Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth, 2002, 89(4): 622-632.
7
McNelis J, Marini CP, Jurkiewicz A, et al. Predictive factors associated with development of abdominal compartment syndrome in the surgical intensive care unit. Arch Surg, 2002, 137(2): 133-136.
8
张春龙,刘建伟. 限制性输液在腹部外科的应用进展[J/CD]. 中华普通外科学文献:电子版, 2009, 3(5): 422-424.
9
Vander Linden P. Volume optimization in surgical patients: wet or dry? Acta Anaesthesiol Belg, 2007, 58(4): 245-250.
10
Kleespies A, Thiel M, Jauch KW, et al. Perioperative fluid retention and clinical outcome in elective, high-risk colorectal surgery. Int J Colorectal Dis, 2009, 24(6): 699-709.
11
Mazurek MF, Growdon JH, Beal MF, et al. CSF vasopressin concentration is reduced in Alzheime's disease. Neurology, 1986, 36(8): 1133-1137.
12
Rashind MA, Peskind ER, Lampe TH, et al. Cerebrospinal fluid vasopressin, oxytocin, somatostatin, and beta-endorphin in Alzheime's disease. Arch Gen Psychiatry, 1986, 43(4): 382-388.
13
袁飞. 关注老年人内分泌系统的变化. 中国老年保健医学杂志, 2010, 8(5): 66-67.
14
Yamada K, Yoshida S. Electrolyte imbalance in the elderly. Nihon Ronen Igakkai Zasshi, 1989, 6(3): 210-215.
15
Noth RH, Mazzaferri EL. Age and the endocrine system. Clin Geriatr Med, 1985, 1(1): 223-250.
16
Powell- Tuck J, Gosling P, Lobo DN, et al. British consensus guidelines on intravenous fluid therapy for adult surgical patients. Anaesthesia, 2009, 64(3): 235-238.
[1] 宋玟焱, 杜美君, 陈佳丽, 石冰, 黄汉尧. 唇腭裂手术围手术期疼痛管理的研究进展及基于生物材料治疗新方法的展望[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 397-405.
[2] 王淑贤, 张良灏, 王利君, 张慧, 郭源, 许传屾, 李志强, 蔡金贞, 解曼, 饶伟. 成人肝移植围手术期严重心血管事件危险因素分析及预测模型研究[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 222-229.
[3] 吴小山, 任桂灵, 朱杰东, 史天陆, 马葵芬. 肾移植受者围手术期霉酚酸暴露量及不良反应分析[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 17-21.
[4] 张斌, 孙代宇, 胡昕, 韩菲, 李久明, 李功雨, 吴伟力, 冯宝富, 彭国辉. 评分系统预测不同经验手术者输尿管软镜术后结石清除率准确性的比较研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 353-360.
[5] 成紫琳, 戴明, 李建华, 马靓. 加速康复外科理念在儿童腹股沟疝围手术期的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 331-335.
[6] 师帅, 马文星, 陈昕, 单良, 王泽正, 段降龙, 吴云桦. 腹壁切口疝围手术期并发症发生危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(01): 83-88.
[7] 吕欣谕, 李雯, 王娟侠, 邹维, 王艳, 雷杰. 围手术期肺康复训练在胸腔镜肺叶切除术中疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 256-259.
[8] 陈先志, 许磊, 冯其柱, 王琦. 布地奈德联合复方异丙托溴铵雾化吸入在老年患者腹腔镜围手术期中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 531-536.
[9] 朱垒, 汪斌, 张爱民, 陈晓燕, 张艳冰, 齐浩龙. 小剂量地塞米松在腹腔镜下经胆囊管胆道探查围手术期中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 339-343.
[10] 蒋坤寅, 韩少宇, 郝成俊, 杨峰, 张振清. 老年髋部骨折术后心脏不良事件的影响因素研究[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(02): 96-102.
[11] 周章明, 余水, 梁张. 老年破裂前循环动脉瘤患者的急诊显微手术治疗研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 106-111.
[12] 阮莎, 王盈盈, 杜健, 邱晓珏. 内镜下贲门缩窄日间手术围手术期个体化护理体会[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(01): 65-66.
[13] 沈海锋, 吕方伊, 顾海华, 常志博, 陈盈, 王苹莉, 吴祖群, 邱福铭, 姚杰, 范军强. 局部进展期肺癌新辅助治疗后胸腔镜袖式肺叶切除术——浙江大学医学院附属第二医院2014—2023年56例回顾性分析[J/OL]. 中华胸部外科电子杂志, 2024, 11(03): 158-166.
[14] 王可涵, 许涛, 周全红. 围术期谵妄与应激的研究进展[J/OL]. 中华老年病研究电子杂志, 2024, 11(03): 45-49.
[15] 张顺, 杨希孟, 陆军, 王海峰, 张东. 是否留置术区引流管对颈动脉内膜切除术围手术期安全性的影响[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(03): 210-214.
阅读次数
全文


摘要