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目的探讨压力记录分析法(PRAM)指导儿童颅脑肿瘤切除术中液体治疗的应用。方法选取择期行颅脑肿瘤切除术的患儿,随机分为两组,试验组以PRAM技术获得的血流动力学参数作为液体治疗的指导,对照组依据“4-2-1”法则补液。试验组分别记录Mostcare监测仪(核心技术为PRAM)所采集的麻醉诱导时(T1)、开放硬脑膜后(T2)、肿瘤切除后(T3)、关颅时(T4)的平均动脉血压(MAP)、心率(HR)、心输出量(CO)、心脏指数(CI)、每搏量(SV)、脉压变异度(PPV)、心脏循环效率(CCE)、最大压力梯度(dp/dt)以及患儿术中补液量、尿量、失血量,随访术后ICU停留时间。对照组记录患儿MAP、HR、术中补液量、尿量、失血量,随访ICU停留时间。结果共纳入24例患儿,每组12例。两组患儿年龄、BMI、麻醉时间的差异无统计学意义(P>0.05)。试验组与对照组比较,补液量[(999±584)ml vs.(1 831±735)ml]、晶体输注量[(634.3±331.3)ml vs.(1 392.7±576.6)ml]、ICU停留时间[(1.08±0.42)d vs.(2.03±1.23)d]显著降低(P<0.05)。试验组各时间点血流动力学指标较对照组更稳定。结论 PRAM技术适用于指导小儿颅脑肿瘤切除术的液体治疗,能有效控制液体输注量,维持稳定的血流动力学状态,减少ICU停留时间。
Objective To investigate the application of pressure recording analysis (PRAM) to guide liquid therapy in children with brain tumor resection. Methods Elective cranial brain tumor resection in children, were randomly divided into two groups, the experimental group obtained by PRAM hemodynamic parameters as a guide to liquid therapy, the control group based on “4-2-1 ” rule Rehydration. The experimental group recorded the mean arterial blood pressure (MAP) at the induction of anesthesia (T1), post-dural (T2), post-tumor excision (T3) (HR), cardiac output (CO), cardiac index (CI), stroke volume (SV), pulse pressure variability (PPV), cardiac cycle efficiency (CCE), maximum pressure gradient (dp / dt) As well as intraoperative fluid volume, urine output, blood loss, follow-up ICU stay time. Control group recorded MAP, HR, intraoperative fluid volume, urine output, blood loss, follow-up ICU stay. Results A total of 24 children were enrolled in this study, with 12 cases in each group. There was no significant difference in age, BMI and anesthesia time between the two groups (P> 0.05). Compared with the control group, the volume of fluid infused ([999 ± 584] ml vs. (1831 ± 735) ml], the amount of transfused liquid [(634.3 ± 331.3) ml vs. (1 392.7 ± 576.6) ml] Residence time [(1.08 ± 0.42) d vs. (2.03 ± 1.23) d] was significantly lower (P <0.05). The hemodynamic indexes in the experimental group were more stable than those in the control group at each time point. Conclusion The PRAM technique is suitable for the liquid therapy of pediatric craniocerebral tumor resection. It can effectively control the volume of liquid transfusion, maintain the stable hemodynamic status and reduce the ICU stay time.