摘要
Abstract
Objective:To investigate the effect of goal-directed fluid therapy combined with lung re-cruitment maneuver on hemodynamics, pulmonary function and postoperative outcomes in patients undergoing esophagectomy. Methods:From Jun. 2015 to May 2016, fifty patients scheduled for esophagectomy were ran-domly divided into control group ( group A, n=25) and therapy group ( group B, n=25) . The operative fluid therapy in the two groups was adjusted by maintaining intrathoracic blood volume index ( ITBVI) in the normal physical range(800~1000 mL/m2). Group B was treated with lung recruitment maneuver via increasing pro-gressively the positive end expiratory pressure (PEEP) at the following time points:before the one-lung ven-tilation( OLV) , before the end of OLV and closing chest, and immediately before extubation. The heart rate ( HR) , mean artery pressure ( MAP ) and intrathoracic blood volume index ( ITBVI) were recorded with pulse indicator continuous cardiac output (PiCCO) system at the following time points:before the surgery (T0), to-tal lung ventilation for 15 min ( T1 ) , one-lung ventilation for 15 min ( T2 ) , 15 min after pulmonary re-ex-pansion ( T3 ) and the end of operation ( T4 ) . The lung function test on the pre-surgery and the 2rd postopera-tive day as well as the incidence of pulmonary complications were assessed. Results: During surgery, MAP, HR,ITBVI were comparable between two groups. No lung recruitment maneuver treatment was terminated due to hemodynamic instability. There was no significantly difference between the two groups in the lung function test before the surgery ( P>0.05) . The lung function test in the group B on the 2rd postoperative day( including FEV1, FVC and FEV1%FVC)were significantly increased compared with group A (P<0.05). In the group B, the incidences of hypoxemia and lung infection were significantly lower than those of control group on post-operative 2 days ( P<0.05) . Moreover, the time to extubation was shorter in the group B than that of control group ( P<0.05) . Conclusion:Administration of goal-directed fluid therapy combined with lung recruitment maneuver in patients undergoing esophagectomy not only guarantees hemodynamic stability but also improves lung function and reduces the incidence of pulmonary complications after the surgery.关键词
目标导向液体治疗/肺复张/食管癌/胸腔内血容量指数Key words
Goal-directed fluid therapy/Lung recruitment maneuver/Esophagectomy/In-trathoracic blood volume index
