目标导向液体管理对胃肠道肿瘤患者炎性细胞因子和预后的影响

Effects of goal-directed fluid management on inflammatory cytokines and prognosis in patients with gastrointestinal tumor

目的探讨目标导向液体管理对胃肠道肿瘤患者围术期内炎性细胞因子的影响。方法选择择期胃肠道肿瘤手术的患者40例,随机分为目标导向液体管理组(S组)和中心静脉压液体管理组(C组)。记录术后住院时间、排气时间、进食流食时间、晶体液量、胶体液量、液体总量、尿量及出血量。记录术前(T0)、手术开始(T1)、手术1 h(T2)、手术2 h(T3)、术毕(T4)的血压(BP)、心率(HR)、中心静脉压(CVP)等情况。分别抽取T0、T2、T4、术后24 h(T5)中心静脉血2 m L,血样用于测定血清TNF-α、IL-6的浓度。结果 2组患者术后排气时间、进食半流食时间、住院时间比较有显著差异。S组T3时CVP显著高于C组(P<0.05)。术毕到术后24 h,S组血清TNF-α和IL-6水平显著低于C组(P<0.05)。结论利用目标导向液体管理可以减轻胃肠道肿瘤患者术后炎症应激反应。

Objective To explore the influence of goal-directed fluid management on the in- flammatory cytokines in the perioperative period in patients with gastrointestinal cancer. Methods A total of 40 patients underwent gastrointestinal tumor surgery were randomly divided into goal-directed fluid management group （group S） and central venous pressure liquid management group （group C）. Postoperative hospital stay, defecation and exhaust time, the time of eating semi-liquid diet, crystalloid requirements, colloid requirements, total liquid, urinary output and bleeding volume were recorded. The BP, HR, CVP were monitored and recorded at the time points of before anesthesia （To ）, the be- ginning of surgery （ Tl ）, one hour after the starting of surgery （ T2 ）, two hours after the starting of surgery （ T3 ） and end of operation （ T4 ）. Authors obtained a 3 mL blood sample for evaluation of TNF- or, IL-6. All samples were obtained at the time points of before anesthesia （TO ）, the end of surgery （T4 ） , 24 h after the surgery （T5） , 48 h after the surgery （T6 ）. Results There were significant differences in time of eating semi-liquid diet, the postoperative hospital stays and the time of defecation and exhaust between two groups. CVP level at T3 in group S was significantly higher than that in group C （ P 〈 0.05 ）. The levels of IL-6 and TNF-in group S were significantly lower than those in group C from end of operation to 24 h after operation （ P 〈 0.05 ）. Conclusion Goal-directed fluid manage- ment can alleviate the reaction of inflammatory cytokines of the patients with gastrointestinal tumor sur- gery.