2013-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660577摘要：重大手術或休克狀態下，輸液及輸液量的選擇，主要影響有三大後遺症：一為肺部後遺症，如肺水腫、ARDS 等等；二為腎臟後遺症；三則影響處置後之發炎反應、間接導致其他器官受損。但過去研究所使用的輸液指標，如中央靜脈壓等等並不足以反映功能性變化。近年來以脈壓變異性作輸液指標，被認為是比較有效的功能性指標。但以脈壓變異性作輸液指標，在特殊的狀況下，仍可能採取不同標準。之前在一般外科腸胃道手術的研究顯示，限制性輸液對接口吻合似乎較有利。 我們在胸腔外科手術上的研究，已有一定的基礎；但關於食道切除及重建病人術中輸液策略，前人的研究仍然未有定論；所以計畫在食道切除及重建的病人，以脈壓變異性(pulse pressure variation, PPV) 為功能性輸液指標，分為限制性及正常輸液兩組，研究是否對術後肺功能、腎功能、發炎反應，肺部併發症和短期預後有影響。 在動物實驗方面，我們計畫在已經建立的休克大白鼠模式下，應用大白鼠體箱測驗；應用不同輸液(如高張性生理食鹽水及交體容易等等)，並以不同指標(如脈壓變異性、或血壓作輸液指標)，測試各個策略對肺部生理功能、腎功能、及發炎反應等等的影響。<br> Abstract: Perioperative fluid application has been a topic of debate in past years. Despite the controversies on crystalloids, colloids; and on the composition of saline fluids, the main focus is now on the amount of applied fluids. However, the traditional monitor for fluid administration such as the central venous pressure and the pulmonary wedge pressure was stated to be less functionally reflective than the newly developed functional monitor by pulse pressure variation (PPV) or by stroke volume variation (SVV). Recently goal-directed fluid therapy based on PPV or SVV becomes popular to optimize the perioperative fluid administration. However, the rational approach to perioperative fluid administration will differ for patients with specific considerations such as pulmonary and renal complications, and postoperative inflammatory consequences. For patients receiving major operation or with circulatory shock condition, the strategy on fluid therapy not only affects the pulmonary, renal function, and the systemic inflammation, it also affect the anastomoses and postoperative complications. So we planned to start a prospective clinical investigation on different goal-directed fluid therapy on patients receiving esophagectomy and reconstruction. We hypotheses that the restrictive strategy may be beneficial for postoperative pulmonary function and gastric tube anastomosis. We planned to compare the pulmonary, renal function, inflammation and the postoperative complication between the restrictive group ( intraoperative PPV > 18%) and the normal group (PPV < 13%); Cardiac output, extravascular lung water will still be obtained by pulsion PiCCO system. The clinical outcomes will be collected retrospectively. Another studies will be carried on the rat shock model. Different fluid resuscitation strategy (different fluids including normal saline, hypertonic saline, colloids….and different goals including PPV directed or blood pressure directed….) will be carried after hemorrhagic and septic shock. Pulmonary functions (including dynamic pulmonary compliance, pulmonary resistance, the pulmonary edema, and histological examination), renal functions (including creatinine, NGAL) and the systemic inflammations will be investigated.