目标导向液体治疗在胸腔镜肺癌根治术中的应用

Application of goal-directed fluid therapy in the thoracoscopic radical resection of lung cancer

目的探讨目标导向液体治疗(GDFT)在胸腔镜肺癌根治术中的应用价值。方法94例行胸腔镜肺癌根治术患者随机分为观察组和对照组。观察组采用GDFT,对照组采用常规液体治疗。比较两组患者围术期的血流动力学指标、术中肺通气功能指标、手术观察指标和认知功能。结果在单肺通气1 h和术毕即刻,观察组的平均动脉压(MAP)、中心静脉压(CVP)、呼吸指数(RI)均明显低于对照组,而脑氧饱和度(rSO_(2))和氧合指数(OI)均明显高于对照组(P<0.05或0.01)。观察组胶体补液量、晶体补液量、尿量、补液总量均明显少于对照组,使用血管活性药物构成比低于对照组(P<0.05或0.01)。术后1 d时,观察组的智力状态检查量表(MMSE)评分明显高于对照组,认知功能障碍发生率低于对照组(P<0.05)。结论在胸腔镜肺癌根治术中采用GDFT能够稳定血流动力学,控制容量负荷,减少血管活性药物的使用率,减轻肺通气功能损伤和降低认知功能障碍发生率。

Objective To investigate the application value of goal-directedfluid therapy(GDFT)in the thoracoscopic radical resection of lung cancer.Methods A total of 94 patients who have received thoracoscopic radical resection of lung cancer were randomly divided into the Observation Group and the Control Group.The Observation Group received GDFT,while the Control Group received conventionalfluid therapy.The hemodynamic indicators,intraoperative pulmonary ventilation function indicators,surgical observation indicators,and cognitive functions between the two groups were compared.Results At 1 h of single lung ventilation and immediately after operation,the MAP,CVP,and RI of the Observation Group were significantly lower than those of the Control Group,while rSO_(2) and OI of the Observation Group were significantly higher than those of the Control Group(P<0.05 or 0.01);the colloid rehydration,crystal rehydration,urine volume,and total rehydration of the Observation Group were significantly less than those of the Control Group,and the proportion of patients using vasoactive drugs in the Observation Group was significantly lower than that of the Control Group(P<0.05 or 0.01).At 1 d after operation,the MMSE score of the Observation Group was significantly higher than that of the Control Group,and the incidence of cognitive impairment of the Observation Group was significantly lower than that of the Control Group(P<0.05).Conclusion GDFT can stabilize hemodynamics,control volume load,reduce the use rate of vasoactive drugs,reduce the damage of lung ventilation function and decrease the incidence of cognitive dysfunction during thoracoscopic radical resection of lung cancer.