Effects of goal-directed colloid infusion on short-term recovery and immune function during colorectal cancer resection
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摘要:
目的 分析以目标导向方式输注胶体液对行结直肠癌切除术患者近期恢复和改善免疫功能的临床价值。 方法 回顾性分析自2019年1月—2020年8月在衢州市人民医院行结直肠癌切除术的164例结直肠癌患者的临床资料，根据术中全麻诱导后目标导向液体治疗是否输注胶体液进行分组，观察组(86例)外周静脉输注胶体液，对照组(78例)外周静脉输注晶体液；比较2组围术期各项信息、不同时间点的中心静脉血氧饱和度(ScvO2)、乳酸(Lac)和血糖(Glu)浓度、手术相关并发症发生情况及体液免疫指标水平。 结果 2组手术时间、术中出血量、补液量、尿量比较差异均无统计学意义(均P>0.05)；观察组术后首次排气时间、排便时间、半流饮食时间、住院时间均短于对照组(均P < 0.05)；2组手术结束时ScvO2、Lac和Glu浓度均较术前增大，手术结束时，2组间ScvO2、Lac和Glu浓度比较差异均无统计学意义(均P>0.05)。观察组恶心呕吐发生率为8.14%，低于对照组的20.51%(P < 0.05)。2组术后体液免疫指标均较术前降低，术后3 d，观察组血清IgG水平高于对照组(P < 0.05)。 结论 结直肠癌切除术中以目标导向方式输注胶体液较输注晶体液，能缩短住院时间，减少恶心呕吐发生，保护免疫功能，值得进一步研究应用。 Abstract:Objective To analyse the clinical value of goal-directed infusion of colloidal fluid in promoting short-term recovery and improving immune function in patients undergoing colorectal cancer resection. Methods The clinical data of 164 colorectal cancer resection patients who underwent colorectal cancer resection in our hospital from January 2019 to August 2020 were retrospectively analysed. According to whether colloidal fluid was injected after intraoperative general anaesthesia induction, the observation group (86 cases) received colloidal fluid peripherally, whilst the control group (78 cases) received crystal fluid peripherally. The perioperative information, central venous oxygen saturation (ScvO2), lactate (Lac) and blood glucose (Glu) concentrations at different time points, the occurrence of surgical complications, and the level of humoral immunity in both groups were compared. Results No statistically significant differences were observed in both groups in terms of operation time, intraoperative blood loss, fluid replacement and urine volume (all P>0.05). The first exhaust time, defecation time, half flow diet time and hospital stay in the observation group were shorter than those in the control group (all P < 0.05). At the end of surgery, the concentrations of ScvO2, Lac and Glu in both groups were not statistically significant (all P>0.05). The incidence of nausea and vomiting in the observation group was 8.14%, which was lower than that in the control group (20.51%), and the difference was statistically significant (P < 0.05). Postoperative humoral immune indexes in both groups were lower than those before surgery. Three days after surgery, the serum IgG and C4 levels in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion Goal-directed infusion of colloidal fluid can shorten the length of hospital stay, reduce nausea and vomiting and protect the immune function of patients after colorectal cancer resection, which deserves further research and application. -
表 1 2组结直肠癌患者手术时间及术中各项指标比较(x±s)
组别 例数 手术时间（min） 出血量（mL） 补液量（mL） 尿量（mL） 对照组 78 196.47±36.69 159.84±28.78 2756.52±358.52 369.56±28.74 观察组 86 208.82±47.81 166.43±32.35 2716.38±319.64 376.42±34.60 t值 1.842 1.373 0.758 1.175 P值 0.067 0.172 0.449 0.139 
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表 2 2组结直肠癌患者术后各项指标比较(x±s，d)
组别 例数 排气时间 排便时间 半流饮食时间 住院时间 对照组 78 1.98±0.36 4.26±0.57 4.69±0.47 6.99±2.57 观察组 86 2.43±0.71 5.13±0.82 5.34±0.69 4.83±1.86 t值 5.039 7.813 6.979 6.206 P值 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 2组结直肠癌患者术前及手术结束时ScvO2、Lac和Glu浓度比较(x±s)
组别 例数 ScvO2(%) Lac(mmol/L) Glu(mmol/L) 术前 手术结束时 术前 手术结束时 术前 手术结束时 对照组 78 73.74±4.89 85.62±6.73a 1.32±0.48 2.67±0.93a 5.46±0.53 6.64±0.82a 观察组 86 74.25±4.56 86.05±5.17a 1.31±0.46 2.59±0.85a 5.37±0.49 6.81±0.84a t值 0.691 0.461 0.136 0.576 1.130 1.309 P值 0.491 0.645 0.892 0.566 0.260 0.192 注：与术前比较，aP < 0.05。
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表 4 2组结直肠癌患者手术相关并发症发生情况比较[例(%)]
组别 例数 恶心呕吐 感染 尿潴留 心律失常 肠道菌群失调 应激性溃疡 对照组 78 16(20.51) 5(6.41) 2(2.56) 2(2.56) 3(3.85) 0(0.00) 观察组 86 7(8.14) 7(8.14) 3(3.49) 1(1.16) 5(5.81) 1(1.16) χ2值 5.193 0.180 0.012 0.007 0.049 0.913 P值 0.023 0.671 0.912 0.932 0.825 0.339
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表 5 2组结直肠癌患者手术前后体液免疫指标比较(x±s，g/L)
组别 例数 IgG IgM IgA C3 C4 术前 术后3d 术前 术后3d 术前 术后3d 术前 术后3d 术前 术后3d 对照组 78 13.82±3.46 8.65±2.14a 1.02±0.39 0.78±0.25a 2.53±1.05 2.22±0.93a 1.08±0.28 0.73±0.16a 0.29±0.12 0.16±0.04a 观察组 86 13.79±3.37 10.79±2.87a 1.05±0.41 0.71±0.22a 2.49±1.13 2.36±0.97a 1.12±0.30 0.77±0.19a 0.30±0.16 0.24±0.09a t值 0.056 5.369 0.479 1.907 0.234 0.941 0.880 1.450 0.449 7.228 P值 0.955 < 0.001 0.633 0.058 0.815 0.348 0.380 0.149 0.654 < 0.001 注：与术前比较，aP < 0.05。
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[1] 中国临床肿瘤学会, 结直肠癌专家委员会. 可切除的进展期结直肠癌围手术期治疗专家共识(2019)[J]. 中华胃肠外科杂志, 2019, 22(8): 701-710. [2] JOOSTEN A, DELAPORTE A, ICKX B, et al. Crystalloid versus colloid for intraoperative goal-directed fluid therapy using a closed-loop system: A randomized, double-blinded, controlled trial in major abdominal surgery[J]. Anesthesiology, 2018, 128(1): 55-66. doi: 10.1097/ALN.0000000000001936 [3] 丁琳, 高志峰, 王晓宇, 等. 目标导向液体治疗中晶体液和胶体液对血管内皮多糖包被的影响[J]. 临床麻醉学杂志, 2018, 34(9): 873-877. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201809013.htm [4] KHAN N, REDING J, GILBERT M, et al. Do multiple isolated vertebral thoracolumbar transverse process fractures increase the risk of ligamentous injury and surgical intervention in the setting of trauma[J]. Open J Mod Nurse, 2018, 8(1): 77-83. http://www.cqvip.com/QK/72780X/20181/HS727802018001006.html [5] WANG Z, DO CARMO J M, ABERDEIN N, et al. Synergistic interaction of hypertension and diabetes in promoting kidney injury and the role of endoplasmic reticulum stress[J]. Hypertension, 2017, 69(5): 879-891. doi: 10.1161/HYPERTENSIONAHA.116.08560 [6] 吴雅娟, 鲁晓梅, 任建光. 肝脏手术经不同目标导向液体治疗策略对组织灌注及患者恢复的影响分析[J]. 中国医师进修杂志, 2018, 41(2): 128-132. doi: 10.3760/cma.j.issn.1673-4904.2018.02.009 [7] 孟改革, 方卫平, 张雷, 等. 目标导向液体治疗下晶体液与胶体液输注对肝切除术患者组织灌注和术后恢复的影响[J]. 临床麻醉学杂志, 2017, 33(6): 557-561. doi: 10.3969/j.issn.1004-5805.2017.06.009 [8] CVETKOVIC A, KALEZIC N, MILICIC B, et al. Hemodynamic stability achievement by application of goal directed fluid therapy with different infusion solutions in colorectal surgery[J]. J BUON, 2018, 23(2): 329-339. http://www.jbuon.com/pdfs/23-2/23-2-329-339.pdf [9] 刘峰, 何宋兵, 郭兴坡, 等. 腹腔镜手术与传统开腹手术对老年结肠癌患者术后生理应激及凝血、认知功能和炎症因子的影响[J]. 中国老年学杂志, 2018, 38(2): 342-344. doi: 10.3969/j.issn.1005-9202.2018.02.036 [10] KURE T, SAKAI H. Transmembrane difference in colloid osmotic pressure affects the lipid membrane fluidity of liposomes encapsulating a concentrated protein solution[J]. Langmuir, 2017, 33(6): 1533-1540. doi: 10.1021/acs.langmuir.6b04643 [11] 谷洁, 高志峰, 王晓宇, 等. 基于不同目标的目标导向液体治疗对高危腹部手术患者围术期血管内皮多糖包被的影响: 前瞻性随机对照研究[J]. 中华麻醉学杂志, 2018, 38(6): 707-711. doi: 10.3760/cma.j.issn.0254-1416.2018.06.018 [12] 单剑锋, 俞耀军. 腹腔镜下结直肠癌术后感染并发症的特点及危险因素分析[J]. 中华全科医学, 2017, 15(7): 1153-1155. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201707019.htm [13] MALLICK-SEARLE T, FILLMAN M. The pathophysiology, incidence, impact, and treatment of opioid-induced nausea and vomiting[J]. J Am Assoc Nurse Pract, 2017, 29(11): 704-710. doi: 10.1002/2327-6924.12532 [14] 王翔, 周婷, 方嘉凯, 等. 目标导向液体治疗在胃肠外科ERAS术中容量管理的应用[J]. 广东医学, 2018, 39(9): 1279-1282. doi: 10.3969/j.issn.1001-9448.2018.09.004 [15] 赵力, 彭静, 周敏, 等. 全麻复合腰硬联合麻醉对低位直肠癌患者腹腔镜手术后时间及血清免疫球蛋白、C3水平变化的影响[J]. 广东医学, 2019, 40(4): 526-530. https://www.cnki.com.cn/Article/CJFDTOTAL-GAYX201904014.htm [16] WOLTHUIS A M, BISLENGHI G, LAMBERCHT M, et al. Preoperative risk factors for prolonged postoperative ileus after colorectal resection[J]. Int J Colorectal Dis, 2017, 32(6): 883-890. doi: 10.1007/s00384-017-2824-6 -
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