围术期目标导向液体治疗对老年胃癌根治术伴高血压患者血流动力学、术后恢复及并发症的影响

Effects of perioperative goal-directed fluid therapy on hemodynamics,postoperative recovery and complications in elderly patients with gastric cancer radical surgery complicated by hypertension

目的探讨围术期目标导向液体治疗(GDFT)对老年胃癌根治术伴高血压患者血流动力学、术后恢复及并发症的影响。方法选取88例老年胃癌根治术伴高血压患者作为研究对象,采用随机数字表法分为治疗组和对照组,每组44例。治疗组围术期采用GDFT,对照组围术期采用常规液体治疗。比较2组患者不同时点的平均动脉压、心率、中心静脉血氧饱和度(ScvO_(2)),以及术后排气时间、术后住院时间、术后并发症发生率。结果2组患者平均动脉压、心率、ScvO_(2)的时间效应(F=60.488、49.789、39.423)、组间效应(F=17.317、12.969、10.101)及交互效应(F=26.415、22.546、17.294)比较,差异均有统计学意义(P<0.05);术毕,治疗组的平均动脉压、心率、ScvO_(2)高于麻醉前,且高于对照组,差异有统计学意义(P<0.05)。治疗组术后排气时间、住院时间依次为(2.25±0.61)、(10.29±1.96)d,分别短于对照组的(2.82±0.71)、(12.36±2.29)d,差异有统计学意义(P<0.05)。治疗组术后并发症总发生率为11.36%,低于对照组的29.54%,差异有统计学意义(P<0.05)。结论将GDFT应用于老年胃癌根治术伴高血压患者围术期,可提供更稳定的血流动力学环境,改善组织灌注情况,加速术后康复进程,并减少术后并发症。

Objective To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on hemodynamics,postoperative recovery,and complications in elderly patientswith gastric cancer radical surgery complicated by hypertension.Methods A total of 88 elderly patients with gastric cancer radical surgery complicated by hypertension were enrolled and randomly divided into treatment group and control group,with 44 patients in each group.The treatment group received GDFT during the perioperative period,while the control group received conventional fluid therapy.The mean arterial pressure,heart rate,and central venous oxygen saturation(ScvO_(2))at different time points,as well as postoperative exhaust time,postoperative hospital stay,and postoperative complication rates were compared between the two groups.Results The time effects(F=60.488,49.789,39.423),intergroup effects(F=17.317,12.969,10.101),and interaction effects(F=26.415,22.546,17.294)of mean arterial pressure,heart rate,and ScvO_(2)in the two groups showed statistically significant difference(P<0.05).After surgery,the mean arterial pressure,heart rate,and ScvO_(2)in the treatment group were higher than those before anesthesia and the control group(P<0.05).The postoperative exhaust time and hospital stay in the treatment group were(2.25±0.61)and(10.29±1.96)days,respectively,which were shorter than(2.82±0.71)and(12.36±2.29)days in the control group(P<0.05).The total incidence of postoperative complications in the treatment group was lower than that in the control group(11.36%versus 29.54%,P<0.05).Conclusion Applying GDFT during the perioperative period for elderly patients with gastric cancer radical surgery complicated by hypertension can provide a more stable hemodynamic environment,improve tissue perfusion,accelerate postoperative recovery,and reduce postoperative complications.