目标导向液体治疗对食管癌手术患者氧供需平衡与免疫功能及术后感染的影响

Effect of goal-directed fluid therapy on oxygen supply-consumption balance,immune function and postoperative infection in patients undergoing esophageal cancer surgery

目的探究目标导向液体治疗(GDFT)对食管癌手术患者氧供需平衡、免疫功能及感染的影响.方法选取中国人民解放军海军军医大学第一附属医院2018年1月-2021年7月120例行食管癌手术患者,围术期使用GDFT治疗的60例患者为GDFT组,使用常规液体治疗的60例患者为对照组,记录两组患者年龄、性别、手术时间和出血量等一般资料;采用中心静脉血氧监测导管监测中心静脉血氧饱和度(ScvO_(2)),根据血气分析结果计算中心静脉-动脉二氧化碳分压净差值(Pcv-aCO_(2))、氧输送指数(DO_(2) I)和氧消耗指数(VO_(2) I);分光光度法测量动脉血乳酸含量;流式细胞仪检测CD_(3)^(+)、CD_(4)^(+)及CD_(8)^(+)水平;免疫比浊法检测血清免疫球蛋白A(IgA)、免疫球蛋白M(IgM)和免疫球蛋白G(IgG)水平.结果GDFT组患者ScvO_(2)、Pcv-aCO_(2)、DO_(2) I、VO_(2) I、CD_(3)^(+)、CD_(4)^(+)、IgA、IgM和IgG水平高于对照组(P<0.05);动脉血乳酸含量和CD_(8)^(+)水平低于对照组(P<0.05);两组患者肺部感染发生无统计学差异,主要致病菌为铜绿假单胞菌(17.31%)、肺炎克雷伯菌(15.38%)和金黄色葡萄球菌(15.38%).结论GDFT可以有效提高患者组织灌注,维持氧供平衡,同时对术后免疫功能恢复发挥正向作用.

OBJECTIVE To explore the effect of goal-directed fluid therapy(GDFT)on intraoperative oxygen supply-consumption balance,postoperative immune function and infection in patients undergoing esophageal cancer surgery.METHODS A total of 120 patients who underwent esophageal cancer surgery in the First Affiliated Hospital of PLA Navy Medical University were enrolled between Jan 2018 and Jul 2021.Among them,60 patients treated with GDFT during the perioperative period were included in the GDFT group,and the other 60 patients treated with conventional fluid therapy were included in the control group.General data of the two groups,including age,gender,operation time and bleeding volume were recorded.Central venous oxygen saturation(ScvO_(2))was monitored by central venous blood oxygen monitoring catheter.The central venous-to-arterial carbon dioxide tension difference(Pcv-aCO_(2)),oxygen delivery index(DO_(2)I)and oxygen consumption index(VO_(2) I)were calculated according to the blood gas analysis results.The content of arterial blood lactic acid was determined by spectrophotometric method,the levels of CD_(3)^(+),CD_(4)^(+)and CD_(8)^(+)were detected by flow cytometry,and the levels of serum IgA,IgM and IgG were detected by immunoturbidimetry.RESULTS The levels of ScvO_(2),Pcv-aCO_(2),DO_(2)I,VO_(2)I,CD_(3)^(+),CD_(4)^(+),IgA,IgM and IgG in the GDFT group were significantly higher than those in the control group(P<0.05),while the levels of lactic acid and CD_(8)^(+)were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of pulmonary infection between the two groups.The main pathogens were Pseudomonas aeruginosa(17.31%),Klebsiella pneumonia(15.38%),and Staphylococcus aureus(15.38%).CONCLUSION GDFT can effectively improve tissue perfusion and maintain oxygen supply-consumption balance,promoting the recovery of immune function after surgery.