每搏量变异度导向液体治疗对腹腔镜胃癌根治术患者肠屏障功能的影响

目的 探讨以每搏量变异度（stroke volume variation，SVV）为目标导向的液体治疗对腹腔镜胃癌根治术患者肠道屏障功能的影响。方法 选取择期行胃癌根治术的患者60例，随机分为目标导向组和常规组，各30例。目标导向组术中根据SVV指导补液。常规组术中根据公式（输液总量=生理需要量+累计丢失量+补偿性扩容量+第三间隙缺失量+手术期间失血量）进行补液。监测患者平均动脉压、心率、心指数。测定患者麻醉前和术后3 d内的血浆肠脂肪酸结合蛋白（I-FABP）和D-乳酸浓度。记录患者术后首次排气时间、术后住院天数及术后不良反应的发生情况。结果 两组患者手术前后心率、平均动脉压和心指数差异无统计学意义。目标导向组患者术中晶体输液量、胶体输液量和总输液量明显少于常规组（P<0.05）。术后3 d常规组患者D-乳酸、I-FABP水平均明显高于目标导向组患者，差异有统计学意义（P<0.01）。目标导向组患者术后首次排气时间和住院时间均明显缩短（P<0.01）。结论 SVV为目标导向液体治疗有助于腹腔镜胃癌根治术中对患者进行精确液体管理，减轻其肠道屏障功能损伤，缩短住院时间。

Effect of stroke volume variation guided fluid therapy on intestinal barrier function in patients undergoing radical gastrectomy

Objective To investigate the effect of stroke volume variation (SVV) guided fluid therapy on intestinal barrier function in patients undergoing laparoscopic radical gastrectomy. Methods 60 patients undergoing elective radical gastrectomy were randomly divided into two groups:group G (goal-directed fluid therapy group, n=30) and group C (classical fluid therapy group, n=30). Group G was given fluid replacement according to the guidance of SVV during operation. Group C was given fluid replacement according to the total amount of infusion (physiological requirement + cumulative loss + compensatory dilatation + loss of the third space + blood loss during operation) during operation. The mean arterial pressure (MAP), heart rate (HR), and cardiac index (CI) were monitored during operation and in recovery room. The concentrations of plasma intestinal fatty acid binding protein (I-FABP) and D-lactic acid were measured before anesthesia and within 3 days after operation. The first exhaust time, postoperative hospital stay, and the occurrence of postoperative adverse reactions were recorded. Results There was no significant difference in MAP, HR, and CI during operation between the two groups. The intraoperative crystalloid infusion volume, colloid infusion volume, and total infusion volume in group G were significantly less than those in group C (P<0.05). Three days after operation, the levels of D-lactic acid and I-FABP in group C were significantly higher than those in group G (P<0.01). The first exhaust time and hospital stay in group G were significantly shorter than those in group C (P<0.01). Conclusions Compared with traditional fluid replacement, SVV guided fluid therapy can reduce the amount of fluid infusion during laparoscopic radical gastrectomy in patients with gastric cancer, ensure good circulatory perfusion, better protect intestinal barrier function and reduce the length of stay of patients afer operation.