目标导向液体管理策略对腹腔镜卵巢癌根治术患者血流动力学、组织灌注指标及炎性细胞因子水平的影响

Effects of Goal-directed Fluid Management Strategy on Hemodynamics,Tissue Perfusion Index and Inflammatory Cytokines in Patients Undergoing Laparoscopic Ovarian Cancer Radical Surgery

目的:探讨目标导向液体管理策略对腹腔镜卵巢癌根治术患者血流动力学、组织灌注指标及炎性细胞因子水平的影响。方法:选择2018年2月至2020年8月我院收治的126例拟行腹腔镜卵巢癌根治手术患者,随机分为两组。对照组(63例)采用传统液体管理,观察组(63例)采用目标导向液体管理策略。比较两组手术时间、术中失血量、输液量、尿量、术后住院时间、使用血管活性药物比例差异,以及血流动力学指标[平均动脉压(MAP)、中心静脉压(CVP)、心输出量(CO),每搏量指数(SVI)、每搏输出量变异度(SVV)、体外循环阻力(SVR),心脏指数(CI)]、组织灌注指标[中心性静脉血氧饱和度(ScvO2)、动脉血乳酸(aLac)、中心静脉-动脉血二氧化碳分压差(Pcv-aCO2)、氧摄取率估计值(O2ERe)、氧供指数(DO2I)]、血清炎性细胞因子[白介素-6(IL-6)、白介素-10(IL-10)、白介素-1β(IL-1β)、高迁移率族蛋白B1(HMGB1)]水平差异。结果:观察组术中失血量、输液量、尿量、术后住院时间均低于对照组(P<0.05),使用血管活性药物比例高于对照组(P<0.05)。观察组建立气腹后30 min(T2)、手术结束时(T3)、苏醒时(T4)MAP、CVP、CO、SVI、CI、SVV、O2ERe、DO2I高于对照组(P<0.05),aLac低于对照组(P<0.05)。观察组气管插管后5 min(T1)、T2、T3、T4血清IL-6、IL-10、HMGB1、IL-1β水平均低于对照组(P<0.05)。结论:目标导向液体管理策略更有助于维持腹腔镜卵巢癌根治术患者围术期血流动力学稳定,并保证组织恰当充分灌注,降低血清炎性细胞因子水平。

Objective: To investigate the effects of goal-directed fluid management strategy on hemodynamics, tissue perfusion index and inflammatory cytokines in patients undergoing laparoscopic ovarian cancer radical surgery. Methods: 126 patients who were admitted to our hospital from February 2018 to August 2020 for laparoscopic ovarian cancer radical surgery were randomly divided into two groups. Conventional fluid management was used in the control group(63 cases) and goal-directed fluid management strategy was used in the observation group(63 cases). The difference in operative time, intraoperative blood loss, infusion volume, urine volume, postoperative hospital stay, and proportion of using vasoactive drugs between the two groups were compared, the levels of hemodynamic index [mean arterial pressure(MAP), central venous pressure(CVP), cardiac output(CO), stroke volume index(SVI), stroke volume variation(SVV), systemic vascular resistance(SVR), cardiac index(CI)], tissue perfusion index [systemic central venous oxygen saturation(ScvO2),arterial lactic acid(aLac), central venous-to-arterial carbon dioxide tension difference(Pcv-aCO2), oxygen extraction estimate(O2 Ere),Oxygen Delivery Index(DO2 I)] and serum inflammatory cytokines [interleukin-6(IL-6), interleukin-10(IL-10), interleukin-1β(IL-1β),high mobiliby group box 1(HMGB1)] were compared between the two groups. Results: The intraoperative blood loss, infusion volume,urine volume and postoperative hospital stay in the observation group were lower than those in the control group(P<0.05), and the proportion of using vasoactive drugs was higher than that in the control group(P<0.05). MAP, CVP, CO, SVI, CI, SVV, O2 Ere and DO2 I were higher in the observation group than in the control group at 30 min(T2) after establishment of pneumoperitoneum, at the end of operation(T3) and at awakening(T4), while aLac was lower than that in the control group(P<0.05). The levels of serum IL-6, IL-10,HMGB1 and Il-1β in the observation group were all lower than those in the control group at 5 min after endotracheal intubation(T1), T2,T3 and T4(P<0.05). Conclusion: The goal-directed fluid management strategy is more helpful to maintain the perioperative hemodynamic stability of patients with laparoscopic ovarian cancer radical surgery, and to ensure adequate tissue perfusion and reduce the level of serum inflammatory cytokines.