Objective Through the use of early liquid therapy program for ICU perioperative elderly patients with hyperlipidemia liquid management,this study did an analysis of its therapeutic effect, with a view to provide a theoretical basis for clinical treatment. Methods 80 cases of perioperative elderly patients with hyperlipidemia were enrolled in this study. Intensive care unit(ICU) was divided into treatment group(40 cases) and control group(40 cases). The treatment group was treated with Ringer's solution 6.5 ml / kg.h for 6 hours after treatment. After 6 hours, patients were treated with conventional surgical rehydration. The control group was treated with conventional surgical rehydration only. Within the treatment group and control group, the levels of lactic acid at 6h,6h,24h,48h and 72h were measured at 6h,24h,48h and 72h after the patients were admitted to the intensive care unit. The acute kidney injury(AKI) incidence, the proportion of vasoactive drugs, the duration of treatment of mechanical ventilation, ICU stay and other items were measured according to the data comparison of the two treatment options. Results There was significant difference between the control group (2 438.6 ± 218.7) and the control group at the same time (1 834.7 ± 196.3) ml (P ＜ 0.05). At the 24h, 48h and 72h of the treatment group, (3 367.1 ± 316.4)ml, (6 058.4 ± 537.1)ml, (8 469.7 ± 547.3)ml, compared with the control group (3 428.6 ± 337.4) ml,(6 139.7 ± 521.8)ml,(8 635.1 ± 531.6)ml. (1.79 ± 0.42)mmol/L,(1.62 ± 0.58)mmol/L at the same time (2.09 ± 0.43) mmol/L. in the treatment group at the same time (P ＞ 0.05) (1.49 ± 0.51)mmol/L, (1.41 ± 0.43)mmol, respectively, and the difference was statistically significant (P＜0.05)(1.45 ± 0.47)mmol/L,(1.36 ± 0.37)mmol/L at the same time (2.81 ± 0.56)mmol/L, the difference was not statistically significant (P ＜ 0.05). The incidence of AKI in the treatment group was 15%, which was significantly higher than that in the control group(P＜0.05). The ratio of vasoactive drugs in the two groups was significantly higher than that in the control group (P ＜ 0.05). Duration, ICU time contrast, the difference was not statistically significant (P ＞ 0.05). Conclusion Early liquid therapy program for ICU perioperative elderly patients with hyperlipidemia liquid management therapy can reduce the incidence of acute renal injury, shorten the duration of hyperlipidemia, so it is worthy to perform on clinical application.%目的 通过使用早期液体治疗方案对ICU围术期老年高乳酸血症患者进行液体管理治疗,分析对患者肾脏的保护效果,以期为临床治疗提供理论依据.方法 选取2014年1月 ～2016年1月武汉中心医院重症监护病房(ICU)围术期老年高乳酸血症患者80例,以随机试验原则分为试验组(40例)和对照组(40例),试验组在治疗开始6 h内选用林格液每小时6.5 ml/kg进行输注,输注根据容量状态适度调整用量,6 h后采用常规外科补液治疗;对照组仅采用常规外科补液治疗.测量比较试验组和对照组患者进入重症监护病房后0、6、24、48和72 h时间点的乳酸值及6、24、48和72 h液体入量;同时比较两组患者急性肾损伤(acute kidney injury,AKI)发病率、应用血管活性药物比例、治疗过程机械通气时长、入住ICU时间等项目,评价两种治疗方案.结果 试验组6 h液体入量(2 438.6 ± 218.7)ml 与对照组同时间(1 834.7 ± 196.3) ml 比较,差异有统计学意义(P ＜0.05);24、48和72 h液体入量(3 367.1 ± 316.4)ml、(6 058.4 ± 537.1)ml和(8 469.7 ± 547.3)ml,与对照组同时间(3 428.6 ± 337.4)ml、(6 139.7 ± 521.8)ml 和(8 635.1 ± 531.6)ml 相比,差异无统计学意义(P ＞ 0.05).试验组 6 和 24 h 乳酸值(1.79 ± 0.42)mmol/L 和(1.62 ± 0.58)mmol/L 与对照组同时间(2.09 ± 0.43)mmol/L 和(1.94 ± 0.52)mmol/L 比较差异有统计学意义(P ＜0.05);0、48 和72 h 乳酸值(2.79 ± 0.51)mmol/L、(1.41 ± 0.43)mmol/L 和(1.38 ± 0.46)mmol/L 与对照组同时间(2.81 ± 0.56) mmol/L、(1.45 ± 0.47)mmol/L和(1.36 ± 0.37)mmol/L比较差异无统计学意义(P＞0.05 ).试验组AKI发生6例,发生率15%,较对照组35%差异有统计学意义(P＜0.05).两组应用血管活性药物比例、治疗过程机械通气时长、入住ICU时间对比,差异无统计学意义(P＞0.05 ).结论 早期液体治疗方案对ICU围术期老年高乳酸血症患者进行液体管理治疗,能够降低患者急性肾损伤发病率,缩短高乳酸血症持续时间,值得在临床中推广应用.
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