Flotrac/Vigileo监测下输液在高龄患者腹腔镜下膀胱癌根治术中的应用

宋振东; 闻绍云; 李欣

doi:10.16766/j.cnki.issn.1674-4152.001865

Flotrac/Vigileo监测下输液在高龄患者腹腔镜下膀胱癌根治术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.001865

1.
台州市中心医院麻醉科，浙江台州 318000
2.
台州市中心医院神经内科，浙江台州 318000
3.
台州市中心医院泌尿外科，浙江台州 318000

基金项目:

浙江省公益技术应用社会发展项目 LGF19H050004

详细信息

通讯作者:
闻绍云, E-mail: wensy@tzzxyy.com

中图分类号: R615 R737.14
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- 文章访问数: 165
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-21
- 网络出版日期: 2022-02-16

Application of fluid infusion under Flotrac/Vigileo monitoring in laparoscopic radical cystectomy for bladder cancer in elderly patients

1.
Department of Anesthesiology, Taizhou Central Hospital, Taizhou, Zhejiang 318000, China

摘要

摘要: 目的探讨Flotrac/Vigileo监测下输液对腹腔镜膀胱癌根治术患者术后恢复和炎症反应的影响。方法选择台州市中心医院2019年1月—2019年12月腹腔镜膀胱癌根治术患者160例，根据随机数字法分为A组和B组，每组80例。A组给予421法液体输注，B组根据Flotrac/Vigileo监测结果进行液体输注。分别采集患者术前、术后1 d、术后3 d和术后7 d外周静脉血，分离血清，采用双抗夹心酶联免疫吸附试验测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、IL-6水平。结果 2组麻醉时间、手术时间、术后苏醒时间、液体总量、出血量和尿量、血流动力学、并发症、住院时间、膀胱容量、最大尿流率、膀胱内压差异无统计学意义(均P > 0.05)。B组胶体液量[(1 291.45±224.83)mL]高于A组(P < 0.05)，晶体液量[(992.13±234.15)mL]低于A组(P < 0.05)。B组肛门排气时间[(61.35±14.16)h]、首次下床时间[(6.34±1.42)h]、恢复进食时间[(3.51±1.07)h]均小于A组(均P < 0.05)。与术前比较，2组术后1 d和术后3 d血清TNF-α、IL-6水平升高(均P < 0.05)，IL-2水平降低(P < 0.05)；B组术后1 d和术后3 d血清TNF-α、IL-6水平高于A组(均P < 0.05)，IL-2水平低于A组(P < 0.05)。结论 Flotrac/Vigileo监测下输液可促进腹腔镜膀胱癌根治术患者术后恢复，抑制围手术期炎症反应。
- Flotrac/Vigileo监护系统 /
- 输液管理 /
- 腹腔镜膀胱癌根治术 /
- 炎症
Abstract: Objective This study aimed to investigate the effects of infusion under Flotrac/Vigileo monitoring on postoperative recovery and inflammatory response in patients undergoing laparoscopic radical cystectomy for bladder cancer. Methods A total of 160 patients undergoing laparoscopic radical cystectomy for bladder cancer in Taizhou Central Hospital from January 2019 to December 2019 were selected and divided into group A and group B by the random number method, with 80 patients in each group. Group A was given liquid infusion based on "4/2/1" rule for Ⅳ, and group B was given liquid infusion according to Flotrac/Vigileo monitoring results. Peripheral venous blood was collected before surgery, 1 day after surgery, 3 days after surgery and 7 days after surgery. Serum samples were separated. Serum levels of tumour necrosis factor-α (TNF-α), interleukin-2 (IL-2) and IL-6 were determined by double-antibody ELISA. Results No significant differences in anaesthesia time, operation duration, postoperative recovering time, total fluid volume, blood loss and urine volume, haemodynamics, complications, length of hospital stay, bladder volume, maximum urine flow rate and bladder pressure were found between the two groups (all P > 0.05). The amount of colloid Ⅳ solution in group B [(1 291.45±224.83) mL] was higher than that in group A (P < 0.05), and the amount of crystalloid Ⅳ solutions in group B [(992.13±234.15) mL] was lower than that in group A (P < 0.05). The anal exhaust time of group B [(61.35±14.16) h], time to post-operative ambulation [(6.34±1.42) h] and time of resuming feeding [(3.51±1.07) h] were all shorter than those of group A (all P < 0.05). Compared with preoperation, the serum levels of TNF-α and IL-6 increased and IL-2 decreased in the two groups at 1 and 3 days after operation (P < 0.05). The serum levels of TNF-α and IL-6 in group B were higher than those in group A, while the serum level of IL-2 was lower than that in group A (P < 0.05). Conclusion Infusion under Flotrac/Vigileo monitoring can promote postoperative recovery and inhibit perioperative inflammatory response in patients undergoing radical laparoscopic radical bladder cancer surgery.
- Flotrac/Vigileo system monitoring /
- Infusion management /
- Laparoscopic radical bladder cystectomy /
- Inflammation

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表 1 2组膀胱癌根治术患者一般资料比较(例)

组别	例数	年龄(x±s，岁)	性别(男/女)	ASA(Ⅰ/Ⅱ/Ⅲ)	体重(x±s，kg，)	身高(x±s，cm)	糖尿病	高血压	冠心病
A组	80	54.13±9.46	53/27	22/50/8	68.24±14.16	165.37±18.42	10	18	7
B组	80	53.76±9.24	54/26	20/51/9	68.53±13.67	164.53±17.59	9	19	6
统计量		0.250^a	0.028^b	0.404^c	0.132^a	0.358^a	0.060^b	0.035^b	0.084^b
P值		0.803	0.867	0.666	0.895	0.721	0.807	0.851	0.772
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组膀胱癌根治术患者手术情况比较(x ±s，min)

组别	例数	麻醉时间	手术时间	术后苏醒时间
A组	80	513.20±92.13	345.16±84.32	31.02±8.57
B组	80	491.25±97.52	337.42±82.13	28.79±7.64
t值		1.463	0.588	1.737
P值		0.145	0.557	0.084

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表 3 2组膀胱癌根治术患者液体出入量比较(x ±s，mL)

组别	例数	液体总量	胶体液量	晶体液量	出血量	尿量
A组	80	3 864.52±532.10	992.13±234.15	2 865.19±264.32	185.46±61.37	647.53±62.35
B组	80	3 792.30±547.58	1 291.45±224.83	2 501.13±259.26	179.54±63.52	654.31±59.48
t值		0.846	8.247	8.795	0.600	0.704
P值		0.399	< 0.001	< 0.001	0.549	0.482

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表 4 2组膀胱癌根治术患者血流动力学比较(x ±s)

组别	例数	项目	T1	T2	T3	T4	T5
A组	80	SBP(mm Hg)	112.36±13.41	96.53±12.62^a	108.52±13.04	104.35±12.81	109.87±11.68
		DBP(mm Hg)	72.35±9.42	64.17±10.24^a	68.19±11.13	68.48±11.85	69.14±11.37
		HR(次/min)	76.35±8.64	73.24±9.37	72.13±9.06	72.58±10.02	73.69±9.62
B组	80	SBP(mm Hg)	113.24±14.02	97.14±13.25^a	107.34±12.76	105.06±11.98	111.13±10.32
		DBP(mm Hg)	73.02±9.84	65.27±10.85^a	68.82±11.25	69.42±12.03	70.52±11.59
		HR(次/min)	76.94±8.57	73.82±9.45	73.02±9.47	73.86±9.51	74.38±9.37
注：与T1比较，^aP < 0.05；1 mm Hg=0.133 kPa。

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表 5 2组膀胱癌根治术患者术后恢复情况(x ±s)

组别	例数	肛门排气时间(h)	首次下床时间(h)	恢复进食时间(h)	并发症(例)	住院时间(d)
A组	80	69.83±15.42	7.02±1.51	4.15±1.14	8	19.86±6.52
B组	80	61.35±14.16	6.34±1.42	3.51±1.07	7	18.92±6.47
统计量		3.623^a	2.934^a	3.661^a	0.074^b	0.915^a
P值		< 0.001	0.004	< 0.001	0.786	0.360
注：^a为t值，^b为χ²值。

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表 6 2组膀胱癌患者根治术后膀胱功能比较(x ±s)

组别	例数	膀胱容量(mL)	最大尿流率(mg/s)	膀胱内压(cm H₂O)
A组	80	351.24±41.23	15.32±2.14	18.79±2.34
B组	80	348.56±39.51	15.46±2.23	18.87±2.41
t值		0.420	0.405	0.213
P值		0.675	0.686	0.832
注：1 cm H₂O=0.098 kPa。

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表 7 2组各时间点血清TNF-α、IL-2、IL-6水平比较(x ±s，ng/L)

组别	例数	项目	术前	术后1 d	术后3 d	术后7 d
A组	80	TNF-α	21.03±4.12	82.13±15.64^a	71.25±13.62^a	22.14±5.02
		IL-2	4.31±0.53	3.12±0.43^a	3.76±0.51^a	4.22±0.64
		IL-6	12.51±5.02	68.73±6.21^a	57.32±6.02^a	14.13±6.14
B组	80	TNF-α	20.57±4.25	71.15±16.24^ab	58.38±12.46^ab	21.37±4.86
		IL-2	4.28±0.49	2.35±0.37^ab	3.12±0.46^ab	4.16±0.62
		IL-6	12.62±4.86	60.57±6.18^ab	48.35±5.46^ab	13.41±6.08
注：组内比较, 与术前比较，^aP < 0.05；2组之间比较, 与A组比较，^bP < 0.05。

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