目标导向液体治疗对肺癌根治术后肺通气功能的影响及对肺栓塞的预防作用

目的:探究目标导向液体治疗对肺癌根治术后肺通气功能的影响及对肺栓塞的预防价值。方法:按照随机数字表法将198例择期行肺癌根治术的肺癌患者分为观察组及对照组，每组99例。对照组及观察组术中分别采用传统补液方式及目标导向液体补液。分别测定并计算术前（T0）、单肺通气30 min（T1）、恢复双肺通气即刻（T2）、双肺通气30 min（T3）、术毕（T4）时呼吸指数（RI）、氧合指数（OI）、血清白介素-6（IL-6）、肿瘤坏死因子α（TNF-α）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）及纤维蛋白原（FIB）等指标，记录手术情况及术后并发症发生情况。结果:观察组晶体液量、总输入量、尿量显著少于对照组（P＜0.05）；与T0比较，T1-T2时RI值显著升高，OI显著降低（P＜0.05）；观察组升高或降低幅度显著低于对照组（P＜0.05）；与T0比较，T1-T4时刻两组患者IL-6、TNF-α、PT、APTT值显著升高（P＜0.05）；FIB显著下降（P＜0.05），观察组各时间点指标升高或降低幅度显著低于对照组（P＜0.05）；观察组总并发症发生率显著低于对照组（P＜0.05）。结论:目标导向液体治疗可减轻肺癌根治术患者肺脏功能损伤，减少术中凝血功能波动，在减轻术后肺功能下降及肺栓塞预防方面可能具有一定价值。

Effect of target-directed fluid therapy on pulmonary ventilation function after radical operation of lung cancer and its preventive effect on pulmonary embolism

Objective:To investigate the effect of target-directed fluid therapy on pulmonary ventilation function after radical operation of lung cancer and its preventive value for pulmonary embolism.Methods:A total of 198 patients with lung cancer who underwent elective radical operation of lung cancer were divided into observation group and control group by the random number table method,with 99 cases in each group.The control group and the observation group were treated with traditional fluid infusion and target-directed fluid infusion,respectively.The respiratory index (RI),oxygenation index (OI),serum interleukin-6 (IL-6),tumor necrosis factor alpha (TNF-α),prothrombin time (PT),activated partial thromboplastin time (APTT) and fibrinogen (FIB) before operation (T0),after 30 min of one-lung ventilation (T1),at recovery of two-lung ventilation (T2),after 30 min of two-lung ventilation (T3) and at the end of operation (T4) were measured and calculated.The condition of operation and postoperative complications were recorded.Results:The volume of crystalloid solution,total input and urine volume of the observation group were significantly smaller than those of the control group (P＜0.05).Compared with T0,the RI value was significantly increased and the OI was significantly decreased from T1 to T2 (P＜0.05).The increase or decrease was significantly smaller in the observation group than the control group (P＜0.05).Compared with T0,the levels of IL-6,TNF-α,PT and APTT in both groups were significantly increased while FIB was decreased significantly from T1 to T4 (P＜0.05).The increase or decrease was significantly smaller in the observation group than the control group (P＜0.05).The total incidence of complications in the observation group was significantly lower than that in the control group (P＜0.05).Conclusion:Target-directed fluid therapy can alleviate lung function damage in patients undergoing radical operation of lung cancer and reduce fluctuations in intraoperative coagulation function.It may be of certain value in reducing postoperative pulmonary function decline and prevention of pulmonary embolism.