术中目标导向液体治疗在腹膜后巨大恶性肿瘤切除术患儿中的应用

Application of intraoperative goal-directed fluid therapy in children undergoing resection of huge retroperitoneal tumor

目的:探讨基于脉压变异度(PPV)的目标导向液体治疗(GDFT)在腹膜后巨大恶性肿瘤切除术患儿中的应用。方法:择期行腹膜后巨大恶性肿瘤切除术患儿64例,年龄0.5~3岁,ASAⅡ-Ⅲ级。随机将患儿分为目标导向液体治疗组(G组)和常规液体治疗组(C组),每组32例。G组以PPV为指导,根据GDFT方案进行液体管理,C组采用常规液体管理。记录手术开始(T1)、手术开始后1 h(T2)、手术结束(T3)的MAP、CVP、PPV、Lac值、TNF-α、IL-6浓度。记录术中输注晶体液量、胶体液量、液体总量、出血量、尿量、手术时间、多巴胺使用率以及排气时间、术后住院时间和恶心呕吐发生率。结果:G组输注晶体液量显著少于C组(P<0.05),而输注胶体液量显著多于C组(P<0.05)。两组术中输注液体总量、出血量、尿量与多巴胺使用率方面差异无统计学意义。T2、T3时刻,G组PPV、TNF-α、IL-6显著低于C组(P<0.05),而两组间MAP、CVP、Lac在各时点差异无统计学意义。G组术后排气时间明显短于C组(P<0.05),而在术后恶心呕吐发生率和住院时间方面两组差异无统计学意义。结论:PPV指导的GDFT可以应用于腹膜后巨大恶性肿瘤切除术患儿,能维持其血流动力学稳定,减少炎症因子IL-6、TNF-α释放,促进胃肠功能恢复,但对术后转归无明显影响。

Objective:To explore the application of goal-directed fluid therapy(GDFT)guided by pulse pressure variation(PPV)in the resection of huge retroperitoneal tumor.Methods:64 cases underwent the resection of huge retroperitoneal tumor(aged 0.5~3 years old,ASA gradeⅡ-Ⅲ)were randomly divided into two groups using a random number table,including GDFT group(group G,n=32)and control group(group C,n=32).Group G was treated with GDFT guided by PPV and group C with conventional liquid therapy.The values of MAP,CVP,PPV,Lac,TNF-αand IL-6 were recorded at the beginning of operation(T1),1 hour after the beginning of operation(T2),and at the end of operation(T3).The requirement for crystalloid fluid and colloid,total volume of fluid infused,bleeding volume,urine volume,operation time,dopamine use rate,exhaust time,postoperative hospital stay time and incidence of nausea and vomiting were recorded.Results:The volume of crystalloid fluid in group G was significantly lower than that in group C(P<0.05),while the volume of colloid fluid in group G was significantly more than that in group C(P<0.05).There was no significant difference between the two groups in the total volume of fluid infused,blood loss,urine volume and dopamine use rate.At T2 and T3,PPV,TNF-αand IL-6 in group G were significantly lower than those in group C(P<0.05),while MAP,CVP and Lac in the two groups had no significant difference at each time point.The postoperative exhaust time in group G was significantly shorter than that in group C.There was no significant difference in the incidence of postoperative nausea and vomiting and the hospital stay time between the two groups.Conclusion:GDFT guided by PPV can be used in children with huge retroperitoneal tumor resection,which can maintain the hemodynamic stability,reduce the release of IL-6,TNF-α,and promote the recovery of gastrointestinal function,but has no significant impact on the postoperative outcome.