下腔静脉变异度联合SVV指导下的目标导向液体治疗在腹腔镜肠癌根治术麻醉管理中的应用

目的 探讨下腔静脉变异度联合每搏量变异度(SVV)指导下的目标导向液体治疗在腹腔镜肠癌根治术患者麻醉管理中的应用效果。方法 选取2021年7月至2022年6月择期行腹腔镜下肠癌根治术患者60例,按照不同目标导向液体治疗分为常规补液组(对照组)和SVV组(观察组)各30例。比较两组术中液体出入量、不同时间点血流动力学和视神经鞘直径(ONSD)、术前及术后实验室指标水平[C反应蛋白(CRP)、下腔静脉变异度、纤维蛋白原(FIB)、血浆血栓素B2(TXB2)],术前及术后1、3 d认知功能。结果 观察组总入量、胶体量低于对照组(P<0.05),两组晶体量比较差异无统计学意义(P>0.05)。两组部分时间点血流动力学和ONSD差异有统计学意义(P<0.05)。术前和术后1 d实验室指标水平差异有统计学意义,且观察组CRP、FIB水平低于对照组,下腔静脉变异度高于对照组(P<0.05)。术前及术后3 d,两组认知功能差异无统计学意义(P>0.05),术后1 d观察组认知功能评分高于对照组(P<0.05)。结论 下腔静脉变异度联合SVV指导下的目标导向液体治疗应用于腹腔镜肠癌根治术患者麻醉管理中,能够优化术中液体管理,减少外科应激,维持患者内环境稳定,降低术后短期认知功能损害程度,于患者术后康复有益。

Objective To investigate the application effect of goal-directed fluid therapy under the guidance of inferior vena cava variation combined with stroke volume variation(SVV)in the anesthesia management of patients undergoing laparoscopic radical resection of colorectal cancer.Methods 60 patients undergoing elective laparoscopic radical resection of colorectal cancer from July 2021 to June 2022 were selected and divided into 30 cases each in the conventional fluid rehydration group(group C)and SVV group(group S)according to different goal-directed fluid therapy.The intraoperative fluid intake and outflow,hemodynamics and optic Nerve Sheath Diameter(ONSD)at different time points,preoperative and operative laboratory indicators[C-reactive protein(CRP),variation of inferior vena cava,fibrinogen(FIB),plasma thromboxane B2(TXB2)]levels,preoperative and operative 1 and 3 d cognitive function were compared between the two groups.Results The total intake and colloid content in group S were significantly lower than those in group C(P<0.05),and there was no statistically significant difference in crystal content between the two groups(P>0.05).The difference in haemodynamics and ONSD between the two groups at some time points was statistically significant(P<0.05).The differences in the levels of laboratory indexes between preoperative and 1 d postoperative were statistically significant,and the variation of inferior vena cava was lower than before surgery.While the levels of CRP and FIB in group S were lower than those in the group C,and the variation of inferior vena cava was higher than that in group C(P<0.05).There was no statistically significant difference in cognitive function between the two groups before operation and 3 days after operation(P>0.05),and the cognitive function scores 1 d after the operation in group S were higher than those in group C(P<0.05).Conclusion The application of goal-directed fluid therapy under the guidance of inferior vena cava variation combined with SVV in the anesthesia management of patients undergoing laparoscopic radical resection of colorectal cancer can optimize intraoperative fluid management,reduce surgical stress,maintain the stability of the patient's internal environment,and reduce the degree of short-term cognitive impairment,and is beneficial to the postoperative rehabilitation of patients.