目标导向液体治疗对老年患者腹腔镜结直肠癌手术多糖包被的影响

Effect of goal⁃directed fluid therapy on the glycocalyx in elderly patients undergoing laparoscopic colorectal cancer surgery

目的探讨目标导向液体治疗(goal⁃directed fluid therapy,GDFT)对老年腹腔镜结直肠癌手术患者多糖包被的影响。方法择期拟行结直肠癌根治术的患者50例,年龄60~85岁,ASA分级Ⅱ、Ⅲ级,依据随机数字表法分为2组(每组25例):对照组(C组),维持MAP 65~90 mmHg(1 mmHg=0.133 kPa),尿量>0.5 ml·kg^(−1)·h^(−1);目标导向液体治疗组(G组),实施GDFT,维持每搏量变异度(stroke volume variability,SVV)<13%、心指数(cardiac index,CI)>2.5 L·min−1·m^(−2)。分别于入室(T_(0))、手术开始1 h(T_(1))和术毕(T_(2))记录心率、MAP、CVP,并于上述时点检测多配体聚糖1(syndecan⁃1,SDC⁃1)、硫酸乙酰肝素(hepa⁃ran sulfate,HS)和TNF⁃α浓度,记录术中液体出入量、血管活性药物应用、术后首次排气时间、住院时间及并发症发生情况。结果与T_(0)比较,两组T_(1)和T_(2)时点SDC⁃1、HS和TNF⁃α浓度升高(P<0.05)。与C组比较,G组T_(1)和T_(2)时点CVP降低,T_(2)时点SDC⁃1、HS和TNF⁃α浓度降低,总输液量、晶体液用量和胶体液用量减少,术后首次排气时间缩短(均P<0.05)。结论老年患者行腹腔镜结直肠癌根治术中以SVV和CI为指导的GDFT可维持合理容量水平,减轻术中全身炎症反应,减少血管内皮多糖包被的降解。

Objective To explore the effect of goal⁃directed fluid therapy(GDFT)on the glycocalyx in elderly patients under⁃going laparoscopic colorectal cancer surgery.Methods A total of 50 patients,aged 60−85 years,American Society of Anesthesiolo⁃gists physical statusⅡorⅢ,who were scheduled for laparoscopic colorectal cancer surgery were enrolled.According to the random number table method,they were divided into two groups(n=25):a control group(group C)and a GDFT group(group G).In group C,mean arterial pressure(MAP)was maintained at 65−90 mmHg(1 mmHg=0.133 kPa),with urine volume>0.5 ml·kg^(−1)·h^(−1).In group G,GDFT was performed,while stroke volume variation<13%and cardiac index>2.5 L·min−1·m^(−2) were maintained.Their heart rate,MAP,and central venous pressure(CVP)were recorded immediately before the patients entered the operating room(T_(0)),1 h after the begin⁃ning of operation(T_(1))and at the end of operation(T_(2)).The concentrations of syndecan⁃1(SDC⁃1),heparan sulfate(HS)and tumor necro⁃sis factor⁃alpha(TNF⁃α)were detected at T_(0)−T_(2).Furthermore,their intraoperative fluid infusion volume,the usage of vasoactive drugs,the first exhaust time,the length of hospitalization stay and postoperative complications were recorded.Results Compared with those at T_(0),the levels of SDC⁃1,HS and TNF⁃αincreased in the two groups at T_(1) and T_(2)(P<0.05).Compared with group C,group G showed decreases in CVP at T_(1) and T_(2),decreases in SDC⁃1,HS and TNF⁃αat T_(2),reduction in total volume,crystal volume and the amount of colloid solution,and shortened first exhaust time(P<0.05).Conclusions GDFT guided by SVV and CI during laparoscop⁃ic colorectal cancer surgery in elderly patients can maintain a reasonable volume level,relieve intraoperative systemic inflammatory re⁃sponse,and reduce the degradation of vascular endothelial glycocalyx.