每搏量变异度指导老年腹腔镜胃癌根治术容量管理的临床研究

Clinical study on the capacity management guided by stroke volume variation in elderly patients with laparoscopic radical gastrectomy for gastric cancer

目的观察每搏量变异度(SVV)指导的目标导向性液体治疗(GDFT)与常规补液对老年腹腔镜胃癌根治术患者术中循环动力学及术后胃肠功能恢复的影响。方法选择择期行腹腔镜胃癌根治术的老年患者80例,采用随机数字表法分为目标组和常规组,常规组采用常规补液方案进行补液;目标组采用SVV为指导的目标管理补液方案进行补液。比较两组术中血流动力学指标和血管活性药物使用情况;比较两组术中输液量及其种类、失血量、尿量、术前术后1d血色素(Hb)、血球压积(Hct)、尿素氮(BUN)、肌酐(Ccr)水平以及术后胃肠功能恢复情况和术后并发症情况(包括恶心呕吐、心力衰竭、肺部感染、吻合口渗漏或腹腔感染、肠梗阻等)。结果 1两组患者基础值(T1点)平均动脉压(MAP)、心率(HR)比较差异均无统计学意义(P>0.05),两组患者麻醉不同时间段比较发现,全麻诱导后即刻(T2)、建立气腹后(T3)、标本切除时(T4)MAP、HR与T1的差值目标组均显著低于常规组(P<0.05),而胃肠吻合时(T5)、手术结束后即刻(T6)MAP、HR与T1的差值两组比较均无统计学意义(P>0.05),两组术中血流动力学不良事件和血管活性药物使用有统计学差异(P<0.05);2术中液体总输入量、晶体输入量目标组均低于常规组(P<0.05),胶体液的输入量目标组高于常规组(P<0.05);3目标组尿量和出血量均低于常规组(P<0.05);4两组术前术后1dHb、Hct、BUN、Ccr水平无明显差异(P>0.05);5目标组术后恢复排气时间、进食流质食物时间和排便时间明显短于常规组(P<0.05),术后并发症低于常规组(P<0.05)。结论以SVV为指导的GDFT方案不仅能够维持老年腹腔镜胃癌根治术患者术中血流动力学的平稳,而且术后胃肠功能恢复快,并发症少,是较传统补液方案更为理想的液体治疗方案。

Objective To observe the effect of goal-directed fluid therapy （GDFT） based on stroke volume variation （SVV） and conventional fluid infusion on the circulation and recovery of gastrointestinal function after laparoscopic radical gastrectomy for gastric cancer in elderly patients. Methods We selected 80 cases of laparoscopic radical gastrectomy and randomly divided them into target group and conventional group. Patients in conventional group received conventional fluid infusion scheme for fluid infusion, and the target group with SVV of target management solution for fluid guide. We compared the varieties of the hemodynamic parameters and application of vasoactive drugs in the two groups. We also compared the two groups in infusion volume and type, blood loss, urine volume; preoperative and postoperative data such as hemoglobin （Hb）, hematocrit （Hct）, blood urea nitrogen （BUN）, and creatinine （Ccr）. Moreover, we observed the postoperative gastrointestinal function recovery and postoperative complications of the two groups. Results The baseline values of MAP and HR （T1） in the two groups of patients did not differ significantly （P〉0.05）. Comparison of the two groups with anesthesia at different time segments in MAP and HR revealed that T1-T2, T1-T3, and T1-T4 differences were significantly lower in the target group than in the conventional group （P〈0.05）, but the two groups had no significant difference in T1-T5, T1-T6 MAP and HR （P〉0.05）. The two groups differed significantly in hemodynamic adverse events and vasoactive drugs administration （P〈0.05）. The total amount of intraoperative fluid and crystal input were lower in the target group than in the conventional group （P〈0.05）. Moreover, colloid input was higher than that in the conventional group （P〈0.05）. The urine and bleeding volumes were lower in the target group than in the conventional group （P〈0.05）. There were not significant differences between the two groups in postoperative day 1 Hb, Hct, BUN and Ccr values （P〉0.05）. The postoperative exhaust recovery time, liquid food intake time and defecation recovery time were significantly shorter in the target group than in the conventional group （P〈0.05）. The postoperative complications were significantly fewer in the target group （P〈0.05）. Conclusion GDFT based on SVV can not only maintain the stable hemodynamics of elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer, but also promote the recovery of postoperative gastrointestinal function and decrease the complications. Therefore, it is superior to the traditional fluid replacement program for fluid treatment.