GDFT联合小剂量间羟胺对老年腹腔镜结直肠癌根治术患者血流动力学的影响

Effects of Goal-directed Fluid Therapy Combined with Low-dose Metaraminol on Hemodynamics in Elderly Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer

目的探讨目标导向液体治疗联合小剂量间羟胺对老年腹腔镜结直肠癌根治术患者术中血流动力学及术后早期肠道功能恢复的影响。方法选取笔者医院择期全身麻醉下行腹腔镜结直肠癌根治术的老年患者90例,患者年龄65~80岁,随机分为常规补液组(C组)、目标导向组(G组)、目标导向联合小剂量间羟胺组(GM组)各30例。记录诱导前10min(T0),诱导后1min(T1),手术开始时(T2),手术开始后1h(T3),手术开始后2h(T4),术毕(T5)时的平均动脉压(MAP)、心率(HR)、心排出量(CO)、心指数(CI)、每搏排出量(SV);记录T0和T5时乳酸浓度;记录术中液体出入量和术后早期肠道功能恢复情况。结果与T0时比较,3组的MAP、HR、CO、CI和SV在T1~5时降低(P<0.05)。与C组比较,G组、GM组的MAP在T1~4时升高(P<0.05),CO、CI和SV在T1和T3时升高(P<0.05),晶体量、液体总量和尿量减少(P<0.05),胶体量增加(P<0.05),T5时的乳酸浓度降低(P<0.05),术后首次排气、排便时间及恢复进食流质时间缩短(P<0.05);与G组比较,GM组的MAP在T1和T3时升高(P<0.05),CO、CI和SV在T1时升高(P<0.05),晶体量、胶体量和液体总量减少(P<0.05),T5时的乳酸浓度降低(P<0.05),术后首次排气、排便时间及恢复进食流质时间差异无统计学意义(P>0.05)。结论目标导向液体治疗联合小剂量间羟胺持续输注有利于维持老年腹腔镜结直肠癌根治术患者术中血流动力学的稳定,有利于改善组织器官的灌注,促进患者术后早期肠道功能的恢复。

Objective To investigate the effects of goal-directed fluid therapy combined with low-dose metaraminol on hemodynamics and early postoperative intestinal function recovery in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods Ninety elderly patients undergoing Laparoscopic radical resection of colorectal cancer,aged 65 to 80 years old,were chosen and randomly divided into the conventional fluid management group(group C),goal-directed fluid therapy group(group G) and goal- directed fluid therapy combined with low-dose metaraminol group(group GM).Hemodynamic indexes were recorded at the time of 10 min before the induction of anesthesia (T0),1 min after the induction of anesthesia (T 1),the start of the surgery(T2),1 h after the start of the surgery (T3),2 h after the start of the surgery (T4) and the end of the surgery (T5).Record the lactic concentration at T0 and T5.The fluid of volume and recovery of intestinal function in early postoperative period were record.Results MAP,HR,CO,CI and SV at T1-5 of three groups were significantly lower than those in T0( P <0.05).MAP of group G and group GM was significantly higher than that of group C at T1-4 ( P <0.05).MAP of group GM was significantly higher than that of group G at T1 and T3( P <0.05).CO,CI and SV of group G and group GM were significantly higher than those of group C at T1 and T3 ( P <0.05).CO,CI and SV of group GM were significantly higher than those of group G at T1( P <0.05).Compared with group C,the total amount of liquid,crystals volume and urine output of group G and group GM decreased significantly( P <0.05),but the colloid volume increased significantly( P <0.05).Crystals volume,colloid volume and the total amount of liquid of group GM were significantly lower than group G( P <0.05),but there was no significant difference in urine volume between group G and group GM ( P >0.05).The lactic concentration of group GM was significantly lower than that of group C and group G at T5 ( P <0.05).The first exhaust time,defecation time and fluid intake time of group G and GM were significantly shorter than those of group C( P <0.05)but there was no significant difference between group GM and group G( P >0.05).Conclusion GDFT combined with low-dose metaraminol in elderly patients undergoing laparoscopic radical resection of colorectal cancer can provide more stable hemodynamics and better organ perfusion,promote early recovery of intestinal function.