围术期液体治疗对肺切除术后急性肺损伤及肾损伤的影响.doc

围术期液体治疗对肺切除术后急性肺损伤及肾损伤的影响
摘要:肺切除术后并发症以肺部并发症最为常见,包括肺炎、急性肺损伤(ALI)、急性呼吸窘迫综合症(ARDS)等,是导致患者死亡的主要原因。液体治疗是围手术期治疗的重要组成部分,其目的在于维持电解质平衡,纠正液体失衡和异常分布等。近年来有研究证实,输液速度与输液量与肺切除术后ALI有关,且限制性液体治疗可能导致急性肾损伤(AKI)。目前,目的导向液体治疗为围术期液体治疗的新理念,对于降低肺切除术后肺部并发症具有重要意义。本文从肺切除术后ALI与围术期液体治疗的相关性、ALI发病机制与围术期液体治疗的关系、AKI与围手术期液体治疗的关系及肺切除术后目的导向液体治疗方面作一综述,以期为临床治疗提供参考依据。
关键词:液体治疗;肺切除术;围手术期;急性肺损伤
中图分类号:R657.3 文献标识码:A DOI:10.3969/j.issn.1006-1959.2019.20.003
文章编号:1006-1959(2019)20-0009-05
Effect of Perioperative Fluid Therapy on Acute Lung Injury and
Renal Injury after Pneumonectomy
WU Jiang,GE Ming-jian
Abstract:Complications after pneumonectomy are most common with pulmonary complications, including pneumonia, acute lung injury (ALI), and acute respiratory distress syndrome (ARDS), which are the leading causes of death. Fluid therapy is an important component of perioperative treatment, with the goal of maintaining electrolyte balance and correcting fluid imbalances and abnormal distribution. In recent years, studies have confirmed that infusion rate and infusion volume are related to ALI after pneumonectomy, and restrictive fluid therapy may lead to acute kidney injury (AKI). At present, the goal-oriented liquid therapy is a new concept of perioperative fluid therapy, which is of great significance for reducing pulmonary complications after pneumonectomy. This article compares the relationship between ALI and perioperative fluid therapy, the relationship between ALI pathogenesis and perioperative fluid therapy, the relationship between AKI and perioperative fluid therapy, and the goal-directed fluid therapy after pneumonectomy. Review, in order to provide a reference for clinical treatment.
Key words:Fluid therapy;Pneumonectomy;Perioperative period;Acute lung injury
肺切除術后肺部并发症是患者死亡的主要原因,其过程由轻微并发症如肺不张和肺炎,发展至严重并发症如急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)[1,2]。ALI和ARDS的发生率因切除范围不同,其发生率也不同,全肺切除术的发生率最高为3%~10%,较小范围的切除术的