限制性液体治疗对老年患者围手术期醛固酮水平的影响

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（DO）、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、每小时液体人量和尿量。结果两组术后3d的动脉血乳酸、每小时液体人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。

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

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, 40 cases）. 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.