目标导向液体治疗对腹腔镜下子宫颈癌根治术后患者胃肠功能的影响  

Effect of goal-directed fluid therapy on gastrointestinal function of patients after laparoscopic radical resection of cervical cancer

作　　者：李志山[1] 于菁 刘友章[1] 张晋峰[1] 张玮玮[1] 郭富全[1] Li Zhishan;Yu Jing;Liu Youzhang;Zhang Jinfeng;Zhang Weiwei;Guo Fuquan(Department of Anesthesiology,Shanxi Provincial People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西省人民医院麻醉科,太原030012

出　　处：《肿瘤研究与临床》2021年第3期204-208,共5页Cancer Research and Clinic

摘　　要：目的探讨目标导向液体治疗(GDFT)对腹腔镜下子宫颈癌根治术患者术后胃肠功能的影响。方法选择2016年10月至2018年9月于山西省人民医院拟行腹腔镜下子宫颈癌根治术患者60例,采用随机数字表法将其分为观察组和对照组,每组30例。观察组采用GDFT,患者桡动脉连接Flotrac/Vigile监测系统,根据平均动脉压(MAP)、每搏量变异度(SVV)和心脏指数的变化指导补液,维持MAP≥60 mmHg(1 mmHg=0.133 kPa)、SVV≤13%、心脏指数2.5~4.0 L·min^(-1)·m^(-2)。对照组采用传统补液方法,根据MAP和中心静脉压(CVP)的变化调整输液速度,维持MAP 60~110 mmHg、CVP 8~12 cmH2O(1 cmH2O=0.098 kPa)。记录术中晶体液和胶体液用量、出血量及尿量,记录术后首次肠鸣音恢复时间、肛门排气时间、术后住院时间和恶心呕吐发生情况。分别于麻醉诱导前和术后12、24、36 h抽取动脉血、中心静脉血测定动脉血乳酸浓度、中心静脉血氧饱和度(ScvO2)和肠型脂肪酸结合蛋白(IFABP)浓度。结果与对照组比较,观察组尿量增加(t=-7.738,P<0.01),晶体液用量降低(t=-13.439,P<0.01),胶体液用量增加(t=-8.360,P<0.01),术后首次肠鸣音恢复时间缩短(t=6.694,P<0.01),肛门排气时间缩短(t=-10.326,P<0.01),术后住院时间缩短(t=-7.377,P<0.01)。观察组术后恶心和呕吐发生率分别为10.0%(3/30)和6.7%(2/30),低于对照组的33.3%(10/30)和26.7%(8/30)(χ^(2)=4.812,P=0.028;χ^(2)=4.320,P=0.038)。与对照组比较,观察组在术后12 h(t=2.983,P=0.004)、24 h(t=6.452,P<0.01)、36 h(t=-3.880,P<0.01)的IFABP浓度降低,在术后12 h(t=-7.377,P<0.01)、24 h(t=-6.036,P<0.01)、36 h(t=-8.933,P<0.01)的乳酸浓度降低,观察组在术后12 h(t=2.710,P=0.009)、24 h(t=2.387,P=0.020)的ScvO2增加。结论GDFT可维持胃肠道黏膜细胞的氧供氧需平衡,促进腹腔镜下子宫颈癌根治术患者的胃肠功能恢复。Objective To explore the effect of goal-directed fluid therapy(GDFT)on the gastrointestinal function of patients after laparoscopic radical resection of cervical cancer.Methods A total of 60 patients who were scheduled for laparoscopic radical resection of cervical cancer in Shanxi Provincial People's Hospital from October 2016 to September 2018 were selected.They were randomly divided into observation group and control group by random number table method,with 30 cases in each group.Patients in the observation group received GDFT,they were connected to the Flotrac/Vigile monitoring system,and the fluid supplementation was guided according to the changes in mean arterial pressure(MAP),stroke volume variability(SVV)and cardiac index,the goal was to maintain MAP≥60 mmHg(1 mmHg=0.133 kPa),SVV≤13%,and cardiac index 2.5-4.0 L·min^(-1)·m^(-2).The conventional fluid therapy was applied in the control group,and the liquid's input speed was adjusted according to the changes of MAP and central venous pressure(CVP)which were respectively maintained at 60-110 mmHg and 8-12 cmH2O(1 cmH2O=0.098 kPa).The crystal/colloid input,bleeding volume and urine output were recorded.The first bowel sounds recovery time,exhaust time,postoperative hospitalization time,and the incidence of nausea and vomiting after surgery were recorded.Arterial blood and central venous blood were drawn before anesthesia induction and 12,24 and 36 hours after operation to determine the concentrations of arterial blood lactate and central venous oxygen saturation(ScvO2)as well as intestinal type fatty acid binding protein(IFABP).Results Compared with the control group,the urine output was increased(t=-7.738,P<0.01),the crystal input was reduced(t=-13.439,P<0.01),the colloid input was increased(t=-8.360,P<0.01),the recovery time of first bowel sounds after surgery was shortened(t=6.694,P<0.01),the exhaust time was shortened(t=-10.326,P<0.01),and the time of postoperative hospitalization was shortened(t=-7.377,P<0.01).The incidence of nausea and vomiting i

关 键 词：宫颈肿瘤 补液疗法 腹腔镜检查 胃肠活动 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]