目标导向液体治疗对腹腔镜直肠癌根治术患者近期恢复的影响

Effect of goal-directed fluid therapy on short-term recovery of patients undergoing laparoscopic radical resection of rectal cancer

目的分析目标导向液体治疗对腹腔镜直肠癌根治术患者的近期疗效。方法选取2019年6月—2021年1月于衢州市人民医院拟行腹腔镜直肠癌根治术的84例患者,采用随机数字表法分为2组,各42例,对照组给予常规输液,观察组采取目标导向液体治疗,比较2组治疗效果。结果观察组术中尿量、晶体液用量、胶体液用量及液体总入量[(367.19±113.80)mL、(1307.14±332.68)mL、(869.48±245.13)mL、(2368.50±515.34)mL]较对照组[(489.80±145.28)mL、(1535.62±408.69)mL、(1060.54±276.39)mL、(2876.80±664.16)mL]减少(t=4.306、2.810、3.352、3.919,均P<0.05)。2组间平均动脉压、心率、局部脑氧饱和度差异有统计学意义(均P<0.05)。观察组术后CD4^(+)、CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组(均P<0.05)。观察组术后拔管时间、肛门排气时间、排便时间、进半流食时间及住院时间短于对照组(均P<0.05)。结论目标导向液体治疗可有效降低患者术中液体出入量,维持血流动力学指标稳定,且对免疫功能影响较小。

Objective To analyse the short-term efficacy of goal-directed fluid therapy in patients undergoing laparoscopic radical resection of rectal cancer.Methods Eighty-four patients undergoing laparoscopic radical resection of rectal cancer in Quzhou People’s Hospital from June 2019 to January 2021 were randomly divided into the control group(42 cases)and observation group(42 cases).The control group was given routine infusion,and the observation group was treated with goal-directed fluid therapy.The therapeutic effects of the two groups were compared.Results The intraoperative urine volume,the amount of lens solution,the amount of colloid solution and the total amount of fluid in the observation group[(367.19±113.80)mL,(1307.14±332.68)mL,(869.48±245.13)mL,(2368.50±515.34)mL]were lower than those in the control group[(489.80±145.28)mL,(1535.62±408.69)mL,(1060.54±276.39)mL,(2876.80±664.16)mL],t=4.306,2.810,3.352,3.919,all P<0.05.The results of repeated measurement analysis of variance showed significant differences in mean arterial pressure,heart rate and regional cerebral oxygen saturation between the two groups(all P<0.05).After operation,the CD4^(+)and CD4^(+)/CD8^(+)levels in the observation group were higher than those in the control group,and CD8^(+)level was lower than that in the control group(all P<0.05).The extubation time,first anal exhaust time,defecation time,half fluid feeding time and hospital stay in the observation group were shorter than those in the control group(all P<0.05).Conclusion Goal-directed fluid therapy can effectively reduce the amount of fluid in and out of patients undergoing laparoscopic radical resection of rectal cancer,maintain the stability of hemodynamic indexes and have little impact on immune function.