摘要
目的探讨目标导向液体治疗(GDFT)对老年结肠癌手术患者肠胃功能恢复及血流动力学的影响。方法将104例行结肠癌根治术老年患者随机均分为GDFT组和常规组,各52例。常规组给予传统输液方案治疗,GDFT组在心脏指数(CI)≥2.5 L/(min·m^2),平均动脉压(MAP)≥65 mm Hg(1 mm Hg=0.133 kPa),每搏量输出量指数(SVI)>35 m L/m^2和每搏输出量变异度(SVV)10%~12%时给予GDFT。结果与术前(T_1)比较,手术开始(T_2)、术中1 h(T_3)、术毕(T_4)时刻两组患者MAP、中心静脉压(CVP)、CI及心输出量(CO)逐渐增加(P<0.05),组间T_2~T_4时刻各指标差异显著(P<0.05);GDFT组总输液量、尿量、失血量均少于常规组(P<0.05),血管活性药物使用率较常规组偏高(P<0.05),排气时间及住院时间均短于常规组(P<0.05);与T_1比较,两组血清神经营养因子-3(NT-3)T_2~T_3先升高,T_4再下降,而血清甘丙肽(GAL)、二胺氧化酶(DAO)及D-乳酸(DLC)水平T_2~T_4持续升高,组间T_2~T_4时刻各指标差异显著(P<0.05);GDFT组和常规组恶心呕吐发生率(5.77%比21.15%)及低血压发生率(1.92%比15.38%)差异显著(P<0.05)。结论老年结肠癌患者围手术期以CI≥2.5 L/(min·m^2),MAP≥65 mm Hg,SVI>35 mL/m^2和10%≤SVV≤12%为靶向液体复苏指导目标,可有效维持围手术期血流动力学稳定,促进组织灌注及肠胃功能恢复,降低术后并发症风险,可安全应用于临床手术治疗。
Objective To investigate the effect of goal-directed fluid therapy（GDFT） on gastrointestinal function recovery and hemodynamics in elderly patients undergoing colon cancer surgery. Methods Totally 104 patients undergoing radical resection of colon cancer were randomly divided into the GDFT group and the routine group,52 cases in each group. The routine group was given the traditional infusion regimen,while the GDFT group was given the GDFT by the cardiac index（CI） ≥ 2. 5 L/（min · m^2）,mean arterial pressure（MAP） ≥ 65 mm Hg（1 mm Hg = 0. 133 k Pa）,stroke volume output index（SVI） 35 m L/m^2 and stroke volume variation（SVV） 10%-12%.Results Compared with those before operation（T1）,the MAP,CVP,CI and cardiac output（CO） of the two groups were increased gradually at the beginning of operation（T2）,at 1 h during operation（T3） and at the end of operation（T4）（P〈0. 05）,and there were significant differences between the two groups at T2-T4（P〈0. 05）. The total infusion volume,urine volume and blood loss in the GDFT group were less than those in the routine group（P〈0. 05）,the utilization rate of vasoactive drugs in the GDFT group was higher than that in the routine group（P〈0. 05）,and the exhaust time and hospital stay in the GDFT group were shorter than those in the routine group（P〈0. 05）. Compared with at T1,the level of serum neurotrophic factor-3（NT-3） was increased at T2-T3 and then decreased at T4,but the levels of serum galanin（GAL）,diamine oxidase（DAO） and D-lactate（DLC） were increased at T2-T4,there were significant differences in the indexes between the two groups at T2-T4（P〈0. 05）. There were significant differences in the incidence rates of nausea and vomiting（5. 77% vs. 21. 15%） and hypotension（1. 92% vs. 15. 38%） in the GDFT group and the routine group（P〈0. 05）. Conclusion Targeted liquid resuscitation guidelines with CI ≥2. 5 L/（min·m^2）,MAP ≥ 65 mm Hg,SVI 35 m L/m^2 and 10% ≤ SVV≤12% in the perioperative period of elderly patients with colon cancer can effectively maintain hemodynamic stability in perioperative period,promote tissue perfusion and gastrointestinal function recovery,and reduce the risk of postoperative complications,which can be safely used in clinical operation.
作者
邹丽丽
孟尽海
王文娟
王志华
李银
Zou Lili;Meng Jinhai;Wang Wenjuan;Wang Zhihua;Li Yin(Department of Anesthesiology,General Hospital of Ningxia Medical University,Yinchuan,Ningxia,China 750001)
出处
《中国药业》
CAS
2018年第12期28-31,共4页
China Pharmaceuticals
基金
宁夏回族自治区自然科学基金[NZ16273]
宁夏医科大学科学研究基金资助项目[XM2016063]
关键词
目标导向液体治疗
老年
结肠癌手术
肠胃功能恢复
血流动力学
goal - directed f luid therapy
elderly
colon cancer surgery
gastrointestinal function recovery
hemodynamics
