不同目标导向液体治疗对食管癌根治术围术期血流动力学及术后谵妄的影响  

Effect of Different Goal-directed Fluid Therapy on Perioperative Hemodynamics and Postoperative Delirium in Patients Undergoing Radical Esophagectomy for Esophageal Cancer

作　　者：姬雅君 闫立华 杨丽娜[1] 单士强[1] 吴水水 JI Yajun;YAN Lihua;YANG Lina;SHAN Shiqiang;WU Shuishui(The First Department of Anesthesiology,Cangzhou Central Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市中心医院麻醉一科,河北沧州061000 [2]沧州市中心医院康复理疗科,河北沧州061000

出　　处：《临床误诊误治》2023年第5期53-58,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生健康委项目(20211257)。

摘　　要：目的探讨不同目标导向液体治疗在食管癌根治术患者中的应用效果。方法回顾性分析2020年1月—2022年6月收治的全麻下行食管癌根治术100例的临床资料,根据液体治疗方法分为传统液体治疗组(C组,n=30)、以胸腔内血容积指数(ITBVI)为目标的导向液体治疗组(I组,n=35)、以每搏量变异度(SVV)为目标的导向液体治疗组(S组,n=35)。比较3组手术相关指标、不同时点血流动力学、血管外肺水指数(EVLWI)、肺血管通透性(PVPI)、血清炎性因子、血乳酸水平及术后谵妄发生率。结果I组、S组输液总量、失血量及尿量少于C组(P<0.05)。C组T3~T5时点平均动脉压、心脏指数(CI)均低于T1时点(P<0.05);I组、S组T3~T5时点CI均高于C组(P<0.05)。C组T6时点EVLWI水平高于T1时点(P<0.05);I组、S组T6时点EVLWI水平低于C组,且I组低于S组(P<0.05)。3组T2~T6时点血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均高于T1时点(P<0.05);I组、S组T3~T6时点血清IL-6、TNF-α水平低于C组(P<0.05)。T6时点I组血乳酸水平低于T1时点,C组血乳酸水平高于T1时点(P<0.05)。I组T6时点血乳酸水平低于S组和C组,且S组低于C组(P<0.05)。I组、S组术后谵妄发生率低于C组(P<0.05)。结论以SVV与ITBVI为目标的导向液体治疗均能维持食管癌根治术中血流动力学稳定,抑制炎症反应,降低术后谵妄发生风险,且以ITBVI为目标的导向液体治疗具有更高的敏感度,可能在改善患者预后方面更具优势。Objective To investigate the application effect of different goal-directed fluid therapy(GDFT)in patients undergoing radical esophagectomy for esophageal cancer.Methods Clinical data of 100 cases undergoing radical esophagectomy for esophageal cancer under general anesthesia from January 2020 to June 2022 were retrospectively analyzed.They were divided into traditional liquid therapy group(group C,n=30)and GDFT group targeting intrathoracic blood volume index(ITBVI)(group I,n=35)and GDFT group targeting stroke volume variability(SVV)(group S,n=35).Operation-related indexes,hemodynamics at different time points,extravascular lung water index(EVLWI),pulmonary vascular permeability index(PVPI),serum inflammatory factors,blood lactic acid level and postoperative delirium incidence were compared among the three groups.Results The total transfusion volume,blood loss and urine volume in groups I and S were less than those in group C(P<0.05).In group C,mean arterial pressure(MAP)and cardiac index(CI)at T3-T5 were lower than those at T1(P<0.05).CI at T3 to T5 of group I and group S was higher than that at T1,and higher in group I than in group C(P<0.05).The EVLWI level of group C at T6 was higher than that at T1(P<0.05).EVLWI level in groups I and S was lower than that in group C at T6,and lower in group I than in group S(P<0.05).Serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)at T2-T6 were higher than those at T1(P<0.05).The serum levels of IL-6 and TNF-αin groups I and S were lower than those in group C at T3-T6(P<0.05).The blood lactic acid level was lower in groups I at T6 was lower than that at T1,which,however,was higher in group C than that at T1(P<0.05).The blood lactic acid level in group I at T6 was lower than that in groups S and C,and lower in group S than in group C(P<0.05).The incidence of postoperative delirium in groups I and S was lower than that in group C(P<0.05).Conclusion GDFT targeting both SVV and GDFT can maintain hemodynamic stability during radical esophagectomy for esophageal cance

关 键 词：食管肿瘤 目标导向液体治疗 血流动力学 血管外肺水指数 肺血管通透性 白细胞介素-6 乳酸 谵妄 

分 类 号：R735.1[医药卫生—肿瘤]