摘要
目的观察目标导向液体治疗(GDFT)在老年腹腔镜直肠癌根治术中的应用价值。方法100例行全麻联合超声引导腹横肌平面阻滞下腹腔镜直肠癌根治术老年患者随机分为观察组和对照组,分别采用GDFT及常规液体治疗。比较两组血流动力学变化、手术观察指标、炎症因子水平、细胞免疫功能及并发症。结果手术1 h时,观察组中心静脉压(CVP)和每搏量变异(SVV)均低于对照组,心指数(CI)和中心静脉血氧饱和度(SvO_(2))高于对照组(P<0.05)。术毕,观察组平均动脉压(MAP)、CI、SvO_(2)、CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)均高于对照组,IL-6和TNF-α水平低于对照组(P<0.05)。观察组补液量、尿量均少于对照组,血管活性药物使用高于对照组,术后排气时间和半流饮食时间早于对照组(P<0.05),并发症低于对照组(P<0.05)。结论GDFT可稳定腹腔镜直肠癌根治术老年患者的血流动力学,减轻炎症反应和细胞免疫抑制,加快术后胃肠功能恢复,降低并发症。
Objective To investigate the application of goal-directed fluid therapy(GDFT)in elderly patients with laparoscopic rectal radical resection(LRRR).Methods One hundredelderly patients with LRRR undergoing general anesthesia with ultrasound-guided transversus abdominis plane block were randomly treated with GDFT(observation group)and conventional liquid therapy(control group).Hemodynamic indexes,operative observation indexes,levels of inflammatory factors,cellular immune function and complications were compared between two groups.Results Central vein pressure(CVP)and stroke volume variation(SVV)were lower but cardiac index(CI)and SvO_(2)were higher in observation group compared to control group 1 h after initiation of surgery(P<0.05).Mean arterial pressure(MAP),CI,SvO_(2),CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)ratio were higher,while IL-6 and TNF-a levels were lower in observation group compared with control group at the end of operation(P<0.05).In addition,compared with control group,fluid infusion,urine volume,postoperative exhaust and semi-liquid diet time,and complications were lower,while usage of vasoactive drugs was higher in observation group(P<0.05).Conclusion GDFT can stabilize hemodynamics,alleviate inflammatory response and cellular immunosuppression,accelerate gastrointestinal recovery,and reduce complications in elderly patients with LRRR.
作者
李敏
廖历兴
姚晓芬
梁大顺
LI Min;LIAO Li-xing;YAO Xiao-fen;LIANG Da-shun(Department of Anesthesiology,Guangdong Agricultural Reclamation Center Hospital,Zhanjiang 524002,China)
出处
《广东医科大学学报》
2021年第6期718-722,共5页
Journal of Guangdong Medical University
基金
广东省医学科学技术研究基金项目(No.C2019099)
湛江市科技计划项目(No.2019B01061)。
关键词
腹腔镜直肠癌根治术
老年
目标导向液体治疗
laparoscopic rectal radical resection
elderly
goal-directed fluid therapy
