目标导向液体管理策略对腹腔镜直肠癌根治术患者血流动力学、组织灌注指标及肝肾功能的影响.

Objective: To investigate the effect of goal-directed fluid management (GDFT) on hemodynamics, tissue perfusion index and liver and kidney function in patients undergoing laparoscopic radical resection of rectal cancer. Methods: From July 2016 to April 2019, 84 patients who underwent laparoscopic rectal cancer radical operation in our hospital were selected, they were randomly divided into control group (n=42) and study group (n=42) according to the method of digital random table. The patients in the control group were given routine infusion plan, and the patients in the study group were given GDFT treatment. The perioperative indexes, body fluid volume, hemodynamics, tissue perfusion indexes, liver and kidney functional of the two groups were compared. Results: There were no significant differences between the two groups in pneumoperitoneum time, operation time, hospitalization time, anesthesia time (P>0. 05) and the recovery time of gastrointestinal function in the study group was shorter than that in the control group (P<0.05). The amount of crystal fluid and total infusion in the study group were less than those in the control group (P<0.05), while the amount of colloid fluid and urine were more than those in the control group (P<0.05). The heart rate (HR) at the time point (T4) after induction was lower in the study group than in the control group (P<0.05). The mean arterial pressure (MAP) at T2 time point was higher in the study group than in the control group, 1 hour from operation T3 and T4 time point MAP were lower than the control group (P<0.05). The arterial lactate (aLac) and blood glucose (Glu) of the study group were lower than those of the control group at T2-T4, and the central venous oxygen saturation (ScvO2) in the study group at T3-T4 was higher than that in the control group (P<0.05). There were no statistically significant differences in glutamic oxaloacetylase (AST), alanine aminotransferase(ALT), Urea nitrogen(BUN) and creatinine(Cr) between the two groups before operation, 3d after operation and 7d after operation (P>0.05). ALT, AST, BUN and Cr of patients in the two groups increased and then decreased 3d after operation and 7d after operation (P<0.05). Conclusions: GDFT has the same effect on liver and kidney function as conventional infusion in laparoscopic rectal cancer radical operation, but GDFT can maintain the stability of hemodynamics, and has a better improvement effect on tissue perfusion and fluid circulation. [ABSTRACT FROM AUTHOR]

目的:探讨目标导向液体管理策略（GDFT）对腹腔镜直肠癌根治术患者血流动力学、组织灌注指标及肝肾功能的影响。方法:选取2016年7月～2019年4月期间我院收治的84例行腹腔镜直肠癌根治术患者,按照随机数字表法分为对照组（n=42）和研究组（n=42）,其中对照组患者予以常规输液方案,研究组予以GDFT治疗,比较两组患者围术期指标、体液容量、血流动力学、组织灌注指标及肝肾功能。结果:两组气腹时间、手术时间、住院时间、麻醉时间比较差异无统计学意义（P>0.05）,研究组胃肠功能恢复时间短于对照组（P<0.05）。研究组晶体液量、总输液量少于对照组（P<0.05）,胶体液量、尿量均多于对照组（P<0.05）。研究组诱导后即刻（T2）～术毕时（T4）时间点心率（HR）低于对照组（P<0.05）;研究组T2时间点平均动脉压（MAP）高于对照组,手术开始1小时（T3）、T4时间点MAP低于对照组（P<0.05）。研究组T2～T4时间点动脉乳酸（aLac）、血糖（Glu）低于对照组,T3～T4时间点中心静脉血氧饱和度（ScvO2）高于对照组（P<0.05）。两组患者术前、术后3d、术后7d谷草转氨酶（AST）、谷丙转氨酶（ALT）、尿素氮（BUN）、肌酐（Cr）组间比较差异无统计学意义（P>0.05）;两组患者术后3d、术后7d的ALT、AST、BUN、Cr均呈先升高后降低趋势（P<0.05）。结论:GDFT与常规输液对腹腔镜直肠癌根治术患者肝肾功能的影响相当,但GDFT可较好地维持机体血流动力学平稳,并且对组织灌注和体液循环具有更好的改善效果。 [ABSTRACT FROM AUTHOR]