结直肠癌切除术中以目标导向方式输注胶体液对近期恢复和免疫功能的影响

  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。 

Effects of goal-directed colloid infusion on short-term recovery and immune function during colorectal cancer resection

  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.