目标导向液体治疗对老年膀胱癌根治术患者术中凝血状态的影响

Influence of goal-directed fluid therapy on intraoperative coagulation state in elderly patients with radical resection of bladder cancer

目的探讨目标导向液体治疗对老年膀胱癌根治术患者术中凝血状态的影响。方法选取本院2012年10月至2014年10月老年膀胱癌根治术患者122例,采用随机数字表法分为2组,61例患者实施常规治疗为对照组,61例患者实施目标导向液体治疗为观察组,比较2组患者术中凝血指标[全血活化凝固时间(ACT)、凝结速率(CR)、血小板功能(PF)、D-二聚体]及相关指标[每搏变异度(SVV)、中心静脉血氧饱和度(ScvO2)、心排血指数(CI)]的改变情况。结果 2组患者T1时ACT、CR、PF、D-二聚体、ScvO2均显著增加,SVV、CI均显著降低,直到手术结束。观察组患者T1、T2、T3、T4时ACT、CR、PF、D-二聚体均明显低于对照组,SVV、ScvO2、CI均明显高于对照组,差异均有统计学意义(P<0.05)。结论目标导向液体治疗有助于维持老年膀胱癌根治术患者术中凝血指标稳定,能提高ScvO2,并降低SVV和CI,值得临床推广使用。

Objective To investigate influence of goal-directed fluid therapy on intraoperative coagulation state in elderly patients with radical resection of bladder cancer.Methods One hundred and twenty-two elderly patients with radical resection of bladder cancer were selected in hospital from October 2012 to October 2014,who were randomly divided into two groups.Sixty one patients received routine treatment as control group.Sixty one patients received goal-directed fluid therapy as observation group.Changes of intraoperative blood coagulation indexes（ACT,CR,PF,D-dimer）and related indexes（SVV,ScvO2,CI）were compared between two groups.Results CT,CR,PF,D-dimer and ScvO2 significantly increased at T1 while SVV and CI significantly decreased in two groups until the end of surgery.ACT,CR,PF and D-dimer at T1,T2,T3,T4 in observation group were significantly lower than those in control group.SVV,ScvO2 and CI in observation group were significantly higher than those in the control group.Differences were statistically significant（P0.05）.Conclusion Goal-directed fluid therapy is helpful to maintain intraoperative coagulation indexes stability in elderly patients with radical resection of bladder cancer,which can improve ScvO2 and reduce SVV,CI.It is worthy of clinical use.