以SVV为指导的液体治疗对复合麻醉下老年腹腔镜结肠癌根治术患者肠道屏障的影响

Effect of liquid therapy guided by SVV on intestinal barrier in elderly patients undergoing laparoscopic radical colonic resection of colon cancer under combined anesthesia

目的观察以每搏变异度(SVV)为指导的液体治疗对全麻复合硬膜外麻醉下老年腹腔镜结肠癌根治术患者肠道屏障的影响,并探讨其机制。方法选取行全麻复合硬膜外麻醉下腹腔镜结肠癌根治术的老年患者120例。根据随机数字表法分为两组各60例,S组以SVV为指导进行液体治疗,C组以中心静脉压(CVP)为指导进行液体治疗。记录两组手术时间、液体输入量、出血量、尿量,检测两组在麻醉前(T0)、气腹建立后(T1)、标本切除时(T2)、手术结束时(T3)的血流动力学指标[平均动脉压(MAP)、心脏指数(CI)、中心静脉压(CVP)、SVV]及微循环灌注指标[中心静脉血氧饱和度(Scv O2)、乳酸(Lac)、氧摄取率估计值(O2ER)、氧输送指数(DO2I)和氧消耗指数(VO2I)]。取T0~T3及术后第1、3天(T4、T5)患者的中心静脉血,测定肠道屏障功能损伤指标血清二氧化酶(DAO)、D-乳酸。记录患者排气时间、住院时间及恶心、呕吐情况。结果与C组比较,S组液体总量、晶体量均减少(P均<0.05),但胶体量、尿量均增多(P均<0.05)。与T0时比较,两组各时点CVP、VO2I、Lac、Scv O2、DO2I、O2ER均升高(P均<0.05),SVV、CI、MAP均降低(P均<0.05)。与C组比较,S组在T1~T3时MAP、CVP均降低(P均<0.05),CI、Scv O2、SVV均升高(P均<0.05);在T2、T3时VO2I、Lac均降低(P均<0.05),DO2I、O2ER均升高(P均<0.05)。与C组比较,S组在T2~T5时的血清DAO、D-乳酸均降低(P均<0.05)。S组住院时间、排气时间均少于C组(P均<0.05),恶心、呕吐发生率低于C组(P<0.05)。结论全麻复合硬膜外麻醉下老年腹腔镜结肠癌根治术患者以SVV为指导进行液体治疗,能够维持血流动力学稳定,保证机体组织器官的氧供需求,从而更好地保护肠道屏障,减少胃肠并发症发生。

Objective To observe the effect of fluid therapy guided by stroke volume variability（ SVV） on intestinal barrier in elderly patients undergoing laparoscopic radical resection of colon cancer under general anesthesia combined with epidural anesthesia,and to explore its mechanism. Methods Totally 120 cases of elderly patients undergoing laparoscopic radical resection of colon cancer under general anesthesia combined with epidural anesthesia were selected. According to the random number table method,they were divided into two groups（ groups S and C） with 60 cases in each. Group S was guided by SVV for liquid treatment,and group C was guided by central venous pressure（ CVP） for liquid treatment. We recorded the operation time,liquid input quantity,bleeding volume,and urine volume of the two groups. The hemodynamic indexes [mean arterial pressure（ MAP）,cardiac index（ CI）,central venous pressure（ CVP）,stroke volume variability（ SVV） ]and microcirculation perfusion indexes [center venous blood oxygen saturation（ Scv O2）,lactic acid（ Lac）,oxygen uptake estimated rate（ O2 ER）,oxygen index（ DO2 I）,and oxygen consumption index（ VO2 I） ] of the two groups were recorded before anesthesia（ T0）,after pneumoperitoneum establishment（ T1）,at the time of specimen resection（ T2）,and at the end of operation（ T3）. The central venous blood of patients at T0-T3,the first and third days after operation（ T4,T5） was collected,and the indexes of serum diamine oxidase（ DAO） and D-lactic acid were measured. The patient＇s exhaust time,hospitalization time,nausea and vomiting were recorded. Results Compared with group C,the total amount of liquid and crystal of group S decreased（ all P〈0. 05）,but the amount of colloid and urine volume increased（ all P〈0. 05）. The CVP,VO2 I,Lac,Scv O2,DO2 I,and O2 ER increased in both groups at each time point as compared with those at T0（ all P〈0. 05）,while SVV,CI and MAP decreased（ all P〈0. 05）. Compared with group C,MAP and CVP decreased at T1-T3（ both P〈0. 05）,while CI,Scv O2 and SVV increased in the group S（ all P〈0. 05）. At T2 and T3,VO2 I and Lac decreased（ both P〈0. 05）,and both DO2 I and O2 ER increased（ both P〈0. 05）. Compared with group C,the serum DAO and D-lactic acid decreased in the group S at T2-T5（ both P〈0. 05）. In the group S,the time of hospitalization and exhaust time were less than that of group C（ P〈0. 05）,and the incidence of nausea and vomiting was lower than that of group C（ P〈0. 05）. Conclusion The fluid therapy guided by SVV on intestinal barrier in elderly patients undergoing laparoscopic radical resection of colon cancer under general anesthesia combined with epidural anesthesia can maintain hemodynamic stability,ensure the body＇s tissues and organs of oxygen supply for demand,so as to better protect the intestinal barrier,and reduce gastrointestinal complications.