Lac、ScvO_(2)与Pcv-aCO_(2)对老年患者全腔镜食管癌根治术时液体管理的指导作用

Role of lactic acid,ScvO_(2),and Pcv-aCO_(2) in guiding liquid management of elderly patients during totally endoscopic radical resection of esophageal cancer

目的探讨乳酸(Lac)、中心静脉血氧饱和度(ScvO_(2))、中心静脉-动脉血二氧化碳分压差(Pcv-aCO_(2))联合常规检测指标指导老年患者全腔镜食管癌根治术单肺通气时液体管理的作用。方法收集2020年6月至2021年4月河北北方学院附属第一医院择期全麻下行全腔镜食管癌根治术的老年患者41例,随机分为观察组(21例)和对照组(20例),均给予全身麻醉。2组患者麻醉诱导期快速静脉输注乳酸林格液250 ml,随后以4~8 ml/(kg·h)的速率持续静脉输注。对照组根据平均动脉压(MAP)和中心静脉压(CVP);观察组根据ScvO_(2)、Pcv-aCO_(2)和Lac调整输液量及血管活性药物使用情况。收集各组患者麻醉诱导前5 min(T_(0))、气管插管后5 min(T_(1))、单肺通气前(T_(2))、单肺通气1 h(T_(3))、单肺通气结束(T_(4))各时间点的心率(HR)、MAP、CVP、尿量、输液量、出血量、Lac、ScvO_(2)、Pcv-aCO_(2)等指标,并进行组间、组内的比较。结果2组患者性别、年龄比较,差异无统计学意义(P>0.05)。组内比较发现,2组MAP、HR在T_(1)~T_(4)时间点均低于T_(0)(P<0.05),T_(1)~T_(4)各时间点间比较均无统计学差异(P>0.05);观察组CVP各时间点差异无统计学意义(P>0.05),对照组CVP在T_(3)、T_(4)时间点较T_(0)~T_(2)明显升高,且T_(3)、T_(4)时间点间差异有统计学意义(P<0.05);2组各时间SPO_(2)差异均无统计学意义(P>0.05)。组间比较显示,2组T_(0)、T_(1)时间点MAP无统计学差异(P>0.05),观察组T_(2)~T_(4)时间点MAP明显高于对照组(P<0.05);2组T_(0)~T_(2)时间点CVP无统计学差异(P>0.05),观察组T_(3)、T_(4)时间点CVP明显低于对照组(P<0.05);2组患者术中出血量、SPO_(2)、HR无统计学差异(P>0.05);观察组尿量明显高于对照组(P<0.05),总输液量、血管活性药物剂量低于对照组(P<0.05)。观察组中T_(0)~T_(2)时间点Lac、ScvO_(2)无明显差异,T_(3)、T_(4)时间点Lac明显升高,ScvO_(2)明显降低(P<0.05);T_(0)~T_(3)时间点Pcv-aCO_(2)无明显变化,T_(4)时间点Pcv-aCO_(2)明显升高(P<0.05)。结论Lac、ScvO_(2)和Pcv-aCO_(2)与老年患者全腔镜食管癌根治术单肺通气具有相关性,单肺通气时间越久,Lac和Pcv-aCO_(2)升高越明显,ScvO_(2)下降越明显。

Objective To explore the use of lactic acid(Lac),central venous oxygen saturation(ScvO_(2)),and central venous-arterial carbon dioxide partial pressure(Pcv-aCO_(2))combined with routine indicators in guiding the fluid management of elderly patients with single-lung ventilation during totally endoscopic radical resection of esophageal cancer.Methods Forty-one elderly patients with esophageal cancer who underwent laparoscopic radical resection under elective general anesthesia at First Affiliated Hospital of Hebei North University from June 2020 to April 2021 were included.The study subjects were randomly divided into an observation group(21 cases)and a control group(20 cases).Patients of the two groups were given a rapid intravenous infusion of 250 ml of lactated Ringer's solution during the anesthesia induction period,followed by continuous intravenous infusion at a rate of 4-8 ml/(kg·h).The control group was based on mean arterial pressure(MAP)and central venous pressure(CVP),and the observation group was based on ScvO_(2),Pcv-aCO_(2) and Lac to adjust the infusion volume and the use of vasoactive drugs.The heart rate(HR),MAP,CVP,urine volume,infusion volume,bleeding volume,Lac,ScvO_(2),Pcv-aCO_(2),and other indicators were recorded and compared between groups at 5 min before induction of anesthesia(T_(0)),5 min after tracheal intubation(T_(1)),before one-lung ventilation(T_(2)),1 h of one-lung ventilation(T_(3)),and the end of one-lung ventilation(T_(4)).Results There were no statistically significant differences in gender or age between the two groups(P>0.05).MAP and HR at T_(1)-T_(4) were significantly lower than those at T_(0) in both groups(P<0.05),but there were no statistically significant differences among T_(1)-T_(4)(P>0.05).There were no significant difference in CVP among all time points in the observation group(P>0.05);in the control group,CVP at T_(3) and T_(4) were significantly higher than those at T_(0)-T_(2),and the difference between T_(3) and T_(4) was also statistically significant(P<0.05).There were no significant difference in SPO_(2) at each time point between the two groups(P>0.05).There was no significant difference between the two groups in MAP at T_(0) and T_(1)(P>0.05);MAP at T_(2),T_(3),and T_(4) were significantly higher in the observation group than in the control group(P<0.05).There was no difference between the two groups in CVP at T_(0)-T_(2)(P>0.05);CVP at T_(3) and T_(4) were significantly lower in the observation group than in the control group(P<0.05).There were no significant differences in intraoperative blood loss,SPO_(2),or HR between the two groups(P>0.05).In the observation group,the urine output was significantly higher,and the total infusion volume and the dose of vasoactive drugs were lower than those of the control group(P<0.05).In the observation group,there was no significant difference in Lac or ScvO_(2) at T_(0)-T_(2),while at T_(3) and T_(4),Lac were significantly increased(P<0.05)and ScvO_(2) was significantly decreased(P<0.05).Pcv-aCO_(2) had no statistically significant difference at T_(0)-T_(3),but it significantly increased at T_(4)(P<0.05).Conclusion Lac,ScvO_(2),and Pcv-aCO_(2) are correlated with single-lung ventilation in elderly patients with totally endoscopic radical resection of esophageal cancer.The longer the single-lung ventilation time,the more obvious increase of Lac and Pcv-aCO_(2) and decrease of ScvO_(2).