目标导向液体治疗对腹腔镜直肠癌根治术老年患者围术期的影响OACSTPCD
Effect of goal-directed fluid therapy on perioperative period of elderly patients undergoing laparoscopic radical resection of rectal cancer
目的:探讨心脏指数与每搏量变异度指导的目标导向液体治疗对腹腔镜直肠癌根治术老年患者围术期的影响.方法:选取2023 年4 月至2023 年8 月限期行腹腔镜直肠癌根治术的70 例老年患者,采用随机数字表法将患者分为常规输液组(C组)与目标导向组(G组),每组35 例;G组予以心脏指数与每搏量变异度指导的目标导向液体治疗,C组予以平均动脉压(MAP)与中心静脉压指导的常规输液治疗.比较两组手术相关指标(液体总量、晶体量、胶体量、尿量、出血量及手术时间),记录两组患者麻醉诱导前(T1)、气管插管后 5 min(T2)、改变体位后 5 min(T3)、改变体位后 60 min(T4)、气腹结束后5 min(T5)、手术结束时(T6)的心率与MAP,T1、T4、T6 时两组患者的pH值与动脉血乳酸含量,T1、拔管后5 min(T7)时烦躁指数、麻醉复苏室并发症发生情况,术后第1 天、第3 天、第7 天心率、MAP及术后并发症.结果:与C组相比,G组术中输注的胶体量多,晶体量少(P<0.05).T3～T6 时,G组MAP高于C组(P<0.05);T2～T6 时,C组MAP均低于同组Tl时(P<0.05),G组除T2、T6 时的MAP低于同组T1 时(P<0.05),T3～T5 时的MAP与T1 时相比差异无统计学意义(P>0.05).T6 时,G组pH值高于C组,动脉血乳酸值低于C组(P<0.05);T6 时,C组动脉血乳酸值较同组T1 时升高(P<0.05).T7 时,G组烦躁指数低于C组(P<0.05).G组术后恶心呕吐、感染、吻合口漏、肠梗阻等并发症发生率低于C组(8.57%vs.28.57%).结论:心脏指数与每搏量变异度指导的目标导向液体治疗可优化腹腔镜直肠癌根治术老年患者术中血流动力学指标,改善组织灌注,减轻麻醉苏醒期不适感,降低术后并发症发生率.
Objective:To explore the effect of the goal-directed fluid therapy guided by cardiac index(CI)and stroke volume variation(SVV)on perioperative period of elderly patients undergoing laparoscopic radical resection of rectal cancer.Methods:From Apr.2023 to Aug.2023,70 elderly patients who underwent laparoscopic radical resection of rectal cancer were selected and randomly divided into conventional infusion group(group C)and goal-oriented group(group G),with 35 patients in each group.Among them,group G was given target-oriented fluid therapy guided by CI and SVV,while group C was given conventional fluid therapy guided by mean arterial pressure(MAP)and central venous pressure.The operation-related indexes(total fluid volume,crystal volume,colloidal volume,urine volume,blood loss and operation time)were compared between the two groups.The heart rate and MAP of two groups were recorded at the time before anesthesia induction(T1),5 min after tracheal intubation(T2),5 min after changing position(T3),60 min after changing position(T4),5 min after pneumoperitoneum end(T5),and the end of surgery(T6).The pH values and arterial lactate(aLac)levels of both groups were recorded at T1,T4,T6.The restlessness index of two groups were recorded at T1 and 5 min after extubation(T7),and the occurrence of complications in anesthesia resuscitation room was recorded.The heart rate and MAP on the first day,the third day and the seventh day after operation and the occurrence of postoperative complications were recorded.Results:Compared with group C,the total amount of colloidal fluid infused during surgery in group G increased,while the total amount of crystal-line fluid decreased(P<0.05).At time T3 to T6,the MAP of group G was higher than that of group C(P<0.05);the MAP of group C from T2 to T6 was lower than that of the same group at Tl(P<0.05),while in group G,except for the lower MAP at T2 and T6(P<0.05),there was no difference in MAP between T3 to T5 and T1(P>0.05).At T6,the pH value of group G was higher than that of group C,while the aLac value was lower than that of group C(P<0.05).The aLac value of group C at T6 was significantly higher than that of the same group at T1(P<0.05).The restlessness index in group G was lower than that in group C at T7(P<0.05).The incidence of postoperative complications such as nausea and vomiting,infection,anastomotic leakage and intestinal obstruction in group G(8.57%)was lower than that in group C(28.57%).Conclusions:Goal-directed fluid therapy guided by CI and SVV can optimize intraoperative hemodynamic indicators,improve tissue perfusion,alleviate discomfort during anesthesia recovery period,and reduce the incidence of postoperative complications in elderly patients undergoing laparoscopic rectal cancer radical surgery.
古丽丽;王建娟;吴海燕;管伟;李希明
滨州医学院第二临床医学院,山东 烟台,264000山东省鲁南眼科医院麻醉科临沂市人民医院麻醉科
临床医学
直肠肿瘤直肠癌根治术腹腔镜检查目标导向液体治疗老年人
Rectal neoplasmsRadical resection of rectal cancerLaparoscopyGoal-directed fluid therapyAged
《腹腔镜外科杂志》 2024 (004)
269-275 / 7
山东省医学会临床科研专项资金项目(YXH2022ZX02089)
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