Clinical Observation Of Goal-directed Fluid Therapy Combined With Dexmedetomidine Be Applied To Patients Undergoing Intracranial Tumor Resection

Objective: Applied the Flo Trac/Vigileo during anesthesia monitoring the stroke volume variability(SVV)to guide fluid therapy on the patients with brain tumor surgery,and auxiliary application of dexmedetomidine fixed vein pump into the right through the observation of vital signs parameters,preoperative and postoperative according to beta protein,mini-mental state examination(MMSE)score index changes,and then discusses goal-directed liquid treatment(GDT)joint dexmedetomidine,mi set more conventional infusion therapy in patients with brain tumor resection is brain protection.Choose better for brain tumor resection in patients with postoperative rehabilitation treatment.Methods:Sixty patients with brain tumor resection were selected.Inclusion criteria: Aged 18-65,BMI18.5-25.9,ASA class I – II.Exclusion criteria: simple intelligence scale(Mini-mental state examination,MMSE)scoring 23 points or less;Nearly two generations have a family history of mental illness and(or)alzheimer’s disease;Have active liver and kidney disease;Mental illness;Taking nitroglycerin,sedatives,antidepressant drugs,narcotic pain medication history;Alcohol and because of other reasons can’t exchange partners.Using randomized controlled methods 60 patients were divided into 4 groups,Group C(conventional liquid treatment group);Group D(dexmedetomidine group);G group(GDT);GD group(GDT joint dexmedetomidine group).Patients home after noninvasive blood pressure,ecg and pulse oxygen saturation monitoring,open upper limb venous pathway,lower left had in radial artery puncture,invasive blood pressure monitoring(G,G D group at the same time connect the Flo Trac/Vigileo monitoring SVV),at the same time the right internal jugular vein puncture.Induction with propofol 1.5-2.5 mg/kg,suitable atracurium 0.2-0.3 mg/kg,0.2-0.4mu g/kg sufentanil,line connection after endotracheal intubation anesthesia machine mechanical ventilation.Tidal volume is set to 8 ml/kg,suck:=1:2,breathing frequency,keep breath at the end of the co2 partial pressure between 35-45 mm Hg.To pump note 3~6 mg/ kg·h propofol+0.1~0.3 mu g/kg· min,fentanyl and intermittent intravenous injection shun maintain anesthesia and muscle relaxant atracurium.M,G D group,within 15 minutes prior to anesthesia induction static point 0.5μg/kg dexmedetomidine,right after the 0.2 μg/kg.h dexmedetomidine will continue to pump into the right until 10 minutes before the end of surgery.Fluid management: the group G,G D group,more than 13% SVV is indicated in patients with intravascular effective circulating blood volume is insufficient,need fluids or blood transfusion to less than 13%;SVV is less than 13%,to 1 ~ 2 ml/kg · h added to maintain the speed of the fluid infusion volume,until the accidental loss of blood or blood volume to reduce the SVV more than 13%,need to speed up the infusion until it is lower than 13%.Group C,group D,according to the mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),and other lines of conventional liquid treatment.All four groups maintain urine> 1 ml/kg· h,Hb> 8 g/d L,CVP 5 ~ 12 cm H2 O,heart rate < 50 times/minute to 0.5 mg atropine static push.Monitoring indicators: before anesthesia induction(T0),after endotracheal intubation(T1),surgery(T2),at the beginning of 2 hours(T3),bi(T4)monitoring hemodynamics indexes.Four groups of patients in record operation time,anesthesia time,intraoperative blood loss.1 d prior to surgery and postoperative 3 d,5 d to MMSE line determination of cognitive function.MMSE score 23 points or less postoperative MMSE score or 2 or more points are compared with the preoperative drop as POCD.Because POCD has the characteristics of weight,night and day,light tests are conducted on 9-10 o ’clock at night.If patients appear restless,deep jump,treatment is not cooperate,memory disorders such as unable to MMSE score directly for POCD.Before the operation,1 d(a1)finish(a2),postoperative 3 d(a3),postoperative 5 d(a4)after venous blood was collected using ELISA method S-100 beta concentration in serum.Results:1 Four groups of the patient’s age,sex,body mass index(kg/m2),anesthesia time(min),and other general information is no statistical difference(P>0.05).2 Hemodynamic indexes,four groups in T0 point MAP,HR,there was no statistically significant difference compared with(P>0.05).Compared with points T0,T1,T3,group C significantly lower MAP,HR significantly faster(P<0.05),D,G Dgroup HR slowed significantly(P<0.05);Compared with group C,D,G,G Din T1-T3 point MAP was obviously higher than that of group C(P<0.05),group D,HR in T1-T4 point G D group were lower than that of group C(P < 0.05).3 Compared with group C,G,GD group,quantity is more,the difference was statistically significant(P<0.05);Four groups of dosage,the dosage of colloidal crystal,total liquid amount,amount of blood loss,blood transfusion and vascular active drug dosage has no statistically significant difference(P> 0.05).4 Four groups of serum called S100 B concentration in a1 point than there was no statistically significant difference(P>0.05);Compared with a1,a2 point of the four groups in the called S100 B concentration higher than a1,a3,a4 point concentration was lower than those of a2 point;Compared with group C,a2,a4 point GDgroup is significantly lower in group C,the difference was statistically significant(P<0.05).5 Four groups of MMSE score than there was no statistically significant difference(P>0.05).6 Four groups of postoperative hospital stay compared with there was no statistically significant difference(P>0.05).One cases of postoperative POCD group C,the other three groups are not happen,there was no statistically significant difference(P> 0.05).Conclusions:1 Goal-directed liquid treatment combined dexmedetomidine set to better maintain stable hemodynamics in patients with brain tumor resection,ensure adequate tissue perfusion,having better brain protection,to improve the prognosis.2 Goal-directed liquid treatment combined dexmedetomidine can reduce postoperative neurological damage markers called S100 B protein level,but not significantly affect cognitive function after surgery.