目标导向液体治疗对腹腔镜直肠癌根治术患者近期恢复的影响

郑群燕; 吴青华; 姬丽婷; 占霖森; 董桂灵

doi:10.16766/j.cnki.issn.1674-4152.002412

目标导向液体治疗对腹腔镜直肠癌根治术患者近期恢复的影响

doi: 10.16766/j.cnki.issn.1674-4152.002412

温州医科大学附属衢州医院衢州市人民医院麻醉科，浙江衢州 324000

基金项目:

浙江省医药卫生科技计划项目 2019RC306

详细信息

通讯作者:
郑群燕，E-mail：zqy3056211@163.com

中图分类号: R735.37 R730.56
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出版历程
- 收稿日期: 2021-09-17
- 网络出版日期: 2022-08-20

Effect of goal-directed fluid therapy on short-term recovery of patients undergoing laparoscopic radical resection of rectal cancer

Department of Anesthesiology, Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People's Hospital), Quzhou, Zhejiang 324000, China

摘要

摘要: 目的分析目标导向液体治疗对腹腔镜直肠癌根治术患者的近期疗效。方法选取2019年6月—2021年1月于衢州市人民医院拟行腹腔镜直肠癌根治术的84例患者，采用随机数字表法分为2组，各42例，对照组给予常规输液，观察组采取目标导向液体治疗，比较2组治疗效果。结果观察组术中尿量、晶体液用量、胶体液用量及液体总入量[(367.19±113.80)mL、(1 307.14±332.68)mL、(869.48±245.13)mL、(2 368.50±515.34)mL]较对照组[(489.80±145.28)mL、(1 535.62±408.69)mL、(1 060.54±276.39)mL、(2 876.80±664.16)mL]减少(t=4.306、2.810、3.352、3.919，均P < 0.05)。2组间平均动脉压、心率、局部脑氧饱和度差异有统计学意义(均P < 0.05)。观察组术后CD4⁺、CD4⁺/CD8⁺高于对照组，CD8⁺低于对照组(均P < 0.05)。观察组术后拔管时间、肛门排气时间、排便时间、进半流食时间及住院时间短于对照组(均P < 0.05)。结论目标导向液体治疗可有效降低患者术中液体出入量，维持血流动力学指标稳定，且对免疫功能影响较小。
- 目标导向液体治疗 /
- 腹腔镜直肠癌根治术 /
- 血流动力学 /
- 局部脑氧饱和度 /
- 免疫功能
Abstract: Objective To analyse the short-term efficacy of goal-directed fluid therapy in patients undergoing laparoscopic radical resection of rectal cancer. Methods Eighty-four patients undergoing laparoscopic radical resection of rectal cancer in Quzhou People's Hospital from June 2019 to January 2021 were randomly divided into the control group (42 cases) and observation group (42 cases). The control group was given routine infusion, and the observation group was treated with goal-directed fluid therapy. The therapeutic effects of the two groups were compared. Results The intraoperative urine volume, the amount of lens solution, the amount of colloid solution and the total amount of fluid in the observation group [(367.19±113.80) mL, (1 307.14±332.68) mL, (869.48±245.13) mL, (2 368.50±515.34) mL] were lower than those in the control group [(489.80±145.28) mL, (1 535.62±408.69) mL, (1 060.54±276.39) mL, (2 876.80±664.16) mL], t=4.306, 2.810, 3.352, 3.919, all P < 0.05. The results of repeated measurement analysis of variance showed significant differences in mean arterial pressure, heart rate and regional cerebral oxygen saturation between the two groups (all P < 0.05). After operation, the CD4⁺ and CD4⁺/CD8⁺ levels in the observation group were higher than those in the control group, and CD8⁺ level was lower than that in the control group (all P < 0.05). The extubation time, first anal exhaust time, defecation time, half fluid feeding time and hospital stay in the observation group were shorter than those in the control group (all P < 0.05). Conclusion Goal-directed fluid therapy can effectively reduce the amount of fluid in and out of patients undergoing laparoscopic radical resection of rectal cancer, maintain the stability of hemodynamic indexes and have little impact on immune function.
- Goal-directed fluid therapy /
- Laparoscopic radical resection of rectal cancer /
- Hemodynamic /
- Local cerebral oxygen saturation /
- Immunity

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表 1 2组行腹腔镜直肠癌根治术患者基线资料比较

Table 1. Comparison of baseline data between two groups of patients undergoing laparoscopic radical resection of rectal cancer

组别	例数	男/女(例)	年龄(x±s，岁)	BMI (x±s)	ASA分级(例)			合并疾病(例)		手术时间(x±s，min)	CO₂气腹流量(x±s，L/min)	腹腔压(x±s，mm Hg)
组别	例数	男/女(例)	年龄(x±s，岁)	BMI (x±s)	Ⅰ级	Ⅱ级	Ⅲ级	高血压	糖尿病	手术时间(x±s，min)	CO₂气腹流量(x±s，L/min)	腹腔压(x±s，mm Hg)
对照组	42	25/17	56.17±8.53	23.82±2.50	11	28	3	19	14	175.42±36.05	1.02±0.23	13.65±1.07
观察组	42	24/18	56.44±7.98	24.07±2.68	9	29	4	20	12	180.12±34.58	1.08±0.25	13.72±1.64
统计量		0.049^a	0.150^b	0.261^b	0.360^c			0.048^a	0.223^a	0.610^b	1.145^b	0.232^b
P值		0.825	0.881	0.795	0.548			0.827	0.637	0.544	0.256	0.817
注: ^a为χ²值，^b为t值，^c为Z值。1 mm Hg=0.133 kPa。

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表 2 2组行腹腔镜直肠癌根治术患者术中液体出入量比较(x±s，mL)

Table 2. Comparison of fluid volume between two groups during laparoscopic radical resection of rectal cancer(x±s, mL)

组别	例数	失血量	尿量	晶体液用量	胶体液用量	液体总入量
对照组	42	125.41±30.12	489.80±145.28	1 535.62±408.69	1 060.54±276.39	2 876.80±664.16
观察组	42	118.72±26.57	367.19±113.80	1 307.14±332.68	869.48±245.13	2 368.50±515.34
t值		1.079	4.306	2.810	3.352	3.919
P值		0.284	< 0.001	< 0.001	0.001	< 0.001

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表 3 2组行腹腔镜直肠癌根治术患者不同时刻MAP、HR比较(x±s)

Table 3. Comparison of MAP and HR between two groups at different time points after laparoscopic radical resection of rectal cancer (x±s)

组别	例数	MAP(mm Hg)				HR(次/min)
组别	例数	T1	T2	T3	T4	T1	T2	T3	T4
对照组	42	110.25±9.50	90.62±7.86^a	94.50±7.41^a	107.97±9.44	77.18±8.79	64.02±6.30^a	66.91±6.82^a	75.32±7.11
观察组	42	110.44±9.27	94.38±7.45^a	98.61±7.88^a	109.11±9.70	77.43±8.15	67.37±6.58^a	70.40±6.77^a	75.80±7.52
t值		0.093	2.250	2.462	0.564	0.135	2.383	2.354	0.301
P值		0.926	0.027	0.016	0.587	0.893	0.019	0.021	0.764
注：与同组T1时刻比较，^aP < 0.05。

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表 4 2组行腹腔镜直肠癌根治术患者不同时刻rSO₂比较(x±s，%)

Table 4. Comparison of rSO₂ at different time points between the two groups of patients undergoing laparoscopic radical resection of rectal cancer (x±s, %)

组别	例数	T1	T2	T3	T4
对照组	42	65.04±2.89	63.58±2.70^a	62.31±2.02	64.88±2.74
观察组	42	64.95±3.01	63.81±2.84^a	63.25±2.14^a	64.60±2.50
t值		0.140	0.380	2.070	0.489
P值		0.889	0.705	0.042	0.626
注：与同组T1时刻比较，^aP < 0.05。

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表 5 2组行腹腔镜直肠癌根治术患者手术前后T淋巴细胞亚群水平比较(x±s)

Table 5. Comparison of T lymphocyte subsets between the two groups before and after laparoscopic radical resection of rectal cancer (x±s)

组别	例数	CD4⁺(%)		CD8⁺(%)		CD4⁺/CD8⁺
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d
对照组	42	38.11±2.30	34.10±2.18^a	24.58±1.89	26.80±1.90^a	1.54±0.18	1.30±0.15^a
观察组	42	37.69±2.68	35.26±2.51^a	24.73±2.02	25.79±1.94^a	1.52±0.20	1.39±0.12^a
t值		0.771	2.261	0.351	2.410	0.482	3.036
P值		0.443	0.026	0.726	0.018	0.631	0.003
注：与同组术前比较，^aP < 0.05。

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表 6 2组行腹腔镜直肠癌根治术患者术后恢复相关指标比较(x±s)

Table 6. Comparison of postoperative recovery related indexes between two groups of patients undergoing laparoscopic radical resection of rectal cancer (x±s)

组别	例数	拔管时间(min)	排气时间(d)	排便时间(d)	进半流食时间(d)	住院时间(d)
对照组	42	14.82±4.60	2.38±0.86	4.25±1.33	4.40±1.41	9.20±3.45
观察组	42	12.74±3.85	2.04±0.57	3.68±1.05	3.79±1.22	7.14±2.80
t值		2.247	2.136	2.180	2.120	3.005
P值		0.027	0.036	0.032	0.037	0.004

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