TEE联合PVI指导目标靶向液体治疗在老年患者腔镜结直肠癌手术中的临床应用  

Clinical application of goal-directed fluid therapy guided by TEE combined with PVI in endoscopic surgery for colorectal cancer in elderly patients

作　　者：姚益冰 曹婧 俞丹红 陆雅萍 李振平 沈徐 YAO Yibing;CAO Jing;YU Danhong;LU Yaping;LI Zhenping;SHEN Xu(Department of Anesthesiology,the First Affiliated Hospital of Jiaxing University,Jiaxing,Zhejiang 314001,China)

机构地区：[1]嘉兴学院附属医院麻醉科,浙江嘉兴314001

出　　处：《重庆医学》2023年第7期981-985,共5页Chongqing medicine

基　　金：浙江省教育厅科研项目(Y202146821)。

摘　　要：目的探讨经食管超声多普勒(TEE)联合脉搏灌注变异指数(PVI)指导目标靶向液体治疗(GDFT)在老年患者腔镜结直肠癌手术中的临床应用价值。方法选取2021年10月至2022年4月于该院择期行腹腔镜下乙状结肠癌或直肠癌根治术的62例老年患者作为研究对象,随机分为G组和T组,每组各31例。G组患者以TEE联合PVI指导术中容量治疗,T组患者按常规方案进行容量治疗。观察2组患者入室时(T1)、麻醉诱导后(T2)、建立人工气腹后即刻(T3)、标本切除(T4)、停止气腹后(T5)、拔除气管导管后(T6)各时间点的血流动力学参数[平均血压(MAP)、心率(HR)、中心静脉压(CVP)];记录术中总液体输入量、血管活性药物使用情况、失血量、手术时间;观察2组术后恢复情况:恶心呕吐发生率、术后排气时间、术后住院时间及术后肠道并发症(术后炎性肠梗阻、吻合口瘘、吻合口出血)。结果2组T1~T6时的MAP、HR、CVP比较,差异无统计学意义(P>0.05);2组患者T3~T6时的CVP高于各自T1时,差异有统计学意义(P<0.05);2组患者T3~T6时的MAP、HR分别与各自T1时比较,差异无统计学意义(P>0.05);2组手术时间、血管活性药物使用情况、失血量比较,差异无统计学意义(P>0.05);G组总液体输入量显著少于T组(P<0.05);G组患者恶心呕吐发生率、术后排气时间、术后住院时间、术后肠道并发症发生率均低于或早于T组,差异有统计学意义(P<0.05)。结论TEE联合PVI指导GDFT治疗在老年患者腔镜结直肠癌手术中可维持循环稳定的同时能减少液体输入量,改善微循环,从而进一步降低老年患者术后的并发症,有利于术后转归,缩短住院时间,节约医疗资源,值得临床推荐。Objective To explore the clinical value of goal-directed fluid therapy(GDFT)guided by transesophageal ultrasound Doppler(TEE)combined with pulse perfusion variability index(PVI)in endoscopic surgery for colorectal cancer in elderly patients.Methods A total of 62 elderly patients who underwent laparoscopic radical resection of sigmoid or rectal cancer in this hospital from October 2021 to April 2022 were selected as the study subjects.They were randomly divided into group G and group T,with 31 patients in each group.Patients in group G were treated with intraoperative volume therapy under the guidance of TEE and PVI,while patients in group T were treated with volume therapy according to routine regimen.The hemodynamic indexes[mean blood pressure(MAP),heart rate(HR),and central venous pressure(CVP)]were observed at each time point of admission(T1),after anesthesia induction(T2),immediately after establishment of artificial pneumoperitoneum(T3),specimen resection(T4),cessation of pneumoperitoneum(T5),and removal of tracheal catheter(T6)in the two groups.The total fluid input,the use of vasoactive drugs,blood loss and operation time were recorded;The postoperative recovery of the two groups was observed:the incidence of nausea and vomiting,postoperative exhaust tim e,postoperative hospital stay,and postoperative intestinal complications(postoperative inflammatory intestinal obstruction,anastomotic leakage,anastomotic bleeding).Results There was no significant difference in MAP,HR and CVP between the two groups at T1 to T6(P>0.05);the CVP at T3 to T6 was significantly higher than that at T1 in both groups,and the difference was statistically significant(P<0.05).The MAP and HR of patients in the two groups at T3 to T6 were not significantly different from those at T1(P>0.05).There was no significant difference between the two groups in operation time,use of vasoactive drugs and blood loss(P>0.05),but the total fluid input in group G was significantly lower than that in group T(P<0.05).The incidence of nausea and vomiti

关 键 词：目标靶向液体治疗 结直肠癌手术 经食管超声多普勒 脉搏灌注变异指数 

分 类 号：R614[医药卫生—麻醉学]