目标导向液体治疗对行腹腔镜结肠癌根治术的高血压老年患者术中心功能状态及其相关因素的影响

Effect of goal-directed fluid therapy on cardiac function and related factors in elderly patients undergoing laparoscopic radical resection of colon cancer with hypertension

目的:对行腹腔镜结肠癌根治术的高血压老年患者术中予目标导向性液体治疗(goal-directed fluid therapy, GDFT),探讨对心功能状态及其相关因素的影响。方法:选择泰州市人民医院2016年5月—2017年12月收治的行腹腔镜下结肠癌根治术高血压老年患者60例,采用随机数字表法分为两组:传统输液组(C组,n=30),以平均动脉压(mean arterial pressure, MAP)、中心静脉压、尿量为指导,行常规输液;目标导向输液组(G组, n=30),以每搏量变异度(stroke volume variation, SVV)、MAP为指导,将心脏指数(cardiac index, CI)≥2.5 L·min-1·m-2作为目标行GDFT。分别记录两组患者手术开始时(T0)、进腹腔时(T1)、肠吻合时(T2)、关腹膜时(T3)、拔气管导管前(T4)的心脏功能指标[MAP、心率(heart rate, HR)、CI、体循环血管阻力指数(systemic vascular resistance index, SVRI)、每搏输出量(stroke volume, SV)、心脏循环效率(cardiac cycle efficiency, CCE)、最大压力梯度(maxmum pressure gradient, dP/dtmax)等]及手术时间、晶体胶体用量、出血量、尿量、输血情况及需处理的心脏事件等。结果:G组患者术中液体入量、出血量、心脏事件的发生例数、输血例数明显少于C组(P<0.05),MAP、CI、SV、CCE、dP/dtmax等指标在T2～T4时间点上明显高于C组(P<0.05),HR、SVRI指标在T3、T4时间点上明显低于C组(P<0.05);G组内各指标相对前一时间点差异无统计学意义(P>0.05),而C组内自T2时间点开始,MAP、CCE、dP/dtmax等指标较前一时间点明显降低(P<0.05),CI、SV两指标T2、T3时间点明显低于前一时间点(P<0.05),HR、SVRI指标T3、T4时间点明显高于前一时间点(P<0.05)。结论:对行结肠癌腹腔镜根治术高血压老年患者行GDFT,对心脏功能及其相关因素影响较小,更利于围术期心脏功能保护。

Objective:To investigate the effect of goal-directed fluid therapy(GDFT)on cardiac function and related factors in elderly patients undergoing laparoscopic radical resection of colon cancer with hypertension.Methods:60 patients with hypertension,undergoing radical resection of colon cancer under laparoscope in our hospital were selected during May 2016 and December 2017.They were divided into two groups:traditional infusion group C(group C,n=30):receive routine fluid therapy based on mean arterial pressure(MAP),central venous pressure(CVP),urine output(UOP);goal-directed fluid therapy group(group G,n=30)received goal-directed fluid therapy based on stroke volume variation(SVV)and MAP with the goal of cardiac index(CI)no less than 2.5 L·min^-1·m^-2.The cardiac function index,such as MAP,heart rate(HR),CI,systemic vascular resistance index(SVRI),stroke volume(SV),cardio circulation efficiency(CCE),maximal pressure gradient(dP/dtmax),etc.were recorded at different stages.Results:The number of intraoperative fluid volume,blood loss,cardiac events and blood transfusion in group G were significantly lower than those in group C(P<0.05).MAP,CI,SV,CCE,dP/dtmax at T2-T4 in group G were significantly higher than those in group C(P<0.05).Both HR and SVRI at T3 and T4 were significantly slower than that in group C(P<0.05).Within group G,each index was not significantly different from that at the previous time point(P>0.05).While from the point of T2,MAP,CCE,dP/dtmax within group C were significantly lower than those at the previous time point(P<0.05).Both CI and SV at T2 and T3 were significantly lower than those at the previous time point.But HR and SVRI at T3 and T4 were significantly faster than those at the previous time point.Conclusion:GDFT has little effect on cardiac function and its related factors in elderly patients undergoing laparoscopic radical operation of colon cancer with hypertension.So that GDFT is more beneficial to perioperative cardiac function protection.