探討食道切除術術中輸液給予對術後恢復之影響

目的：台灣惡性腫瘤已連續34年高居國人死因首位，2015年食道癌為癌症十大死因的第九位，一年奪走一千八百多條性命。手術中不恰當的輸液可導致嚴重的臨床後果。因此，本研究是探討食道切除術術中輸液量給予多與少對術後恢復之影響。方法：本研究採回溯性病歷研究，分析中部某醫學中心從2014年1月1日到2016年12月31日期間，因食道癌行食道切除手術之病人為研究對象，所得的樣本數162位，分為術中有使用及無使用PiCCO兩組，研究工具以 Excel建檔分類，採用 SPSS for Windows 22.0版軟體進行統計分析。結果：術中使用 PiCCO的這組，術中尿量多(平均約多 400毫升)，輸注黃血較少，使用代用血漿較多(平均約多150毫升)，缺點是造成術中體溫較低(平均約 0.3℃)，有可能是輸注代用血漿時，沒有加溫代用血漿，導致術中體溫較低。優點是第一次灌食時間提早(平均約早 2.4天)，鼻胃管留置時間縮短(平均約減少 2.5 天)，腸胃功能恢復較快。結論：長時間及重大手術之輸液量維持，需依賴麻醉專業的照護，以穩定病人的血液動力學，以改善病患的預後及加快康復。PiCCO的各項參數，能夠提供做為臨床液體補充或脫水與否的指標，本研究證實當施行食道癌手術時，術中 PiCCO 的使用是值得考量及推廣的最佳選擇。

關鍵字

食道切除術；中心靜脈壓；靜脈輸液調控；心肺容積監視器

並列摘要

Objective:The malignant tumors have been the first 34 consecutive years of death in Taiwan, Esophageal cancer is the ninth most serious cause of cancer in2015, one year away more than 1,800 lives. Improper infusion during surgery can lead to serious clinical consequences. Therefore, this study is to explore the operation of esophageal surgery to give more and less on the impact of postoperative recovery. Methods: In this study, the study of the retrospective medical records, analysis of a medical center in central China from January 1, 2014 to December 31, 2016, due to esophageal cancer esophagectomy surgery for the study of the object, the number of samples obtained 162 , divided into intraoperative use and no use PiCCO two groups, research tools to Excel file classification, using SPSS for Windows 22.0 version of the software for statistical analysis. Results: The use of PiCCO in this group, intraoperative urine output (average about 400 ml), infusion of less blood, the use of more plasma (an average of about 150 ml), the disadvantage is caused by lower body temperature (average about 0.3 degrees C), there may be infusion of alternative plasma, there is no warming alternative plasma, resulting in lower body temperature. The advantage is that the first feeding time is early (about 2.4 days on average), nasogastric tube retention time is shortened (average reduction of about 2.5 days), gastrointestinal function recovery faster. Conclusion: prolonged and major surgery to maintain the amount of infusion, need to rely on anesthesia professional care to stabilize the patient's hemodynamics to improve the prognosis of patients and improve recovery. PiCCO parameters, can provide as a clinical liquid supplement or dehydration or not the indicators, this study confirmed when the implementation of esophageal cancer surgery, intraoperative use of PiCCO is worth considering and promote the best choice.