目标导向液体治疗对腹腔热灌注化疗患者机体氧供需平衡及组织灌注的影响

目的探讨目标导向液体治疗(goal-directed fluid therapy,GDFT)对腹膜癌行腹腔热灌注化疗术患者围术期机体氧供需平衡及组织灌注的影响。方法选择择期全麻下行腹膜癌热灌注化疗的患者80例,男61例,女19例,年龄30~60岁,ASAⅠ~Ⅲ级,随机分为常规液体治疗组(C组)和每搏变异度(SVV)为导向液体治疗组(S组),每组40例。术中应用FloTrac/Vigile系统连续监测血流动力学,记录入手术室后(T0)、气管插管后5 min(T_1)、腹腔热灌注化疗开始前(T_2),热灌注化疗30min(T_3)、热灌注化疗60min(即热灌注结束时,T_4)、热灌注化疗结束后30min(T_5)、手术结束时(T_6)的MAP、HR、CVP、CI、PaO_2、SaO_2、PvO_2、ScvO_2和Lac。根据公式计算氧供(DO2I)及氧耗指数(VO2I)。结果 S组患者输液总量,晶体液量及尿量明显低于C组患者,但胶体液量明显高于C组(P0.05)。与T_1时比较,T_3、T_4时两组患者MAP明显降低,T_4时C组HR明显增快、CI明显降低,T_3~T_6时C组和T_3~T_5时S组CVP明显升高(P0.05);T_3~T_5时S组患者MAP及CI明显高于C组,HR明显慢于C组(P0.05)。与T_1时比较,T_4、T_5时C组DO2I明显降低,T_3~T_6时C组VO_2I,O_2ER及Lac水平明显升高,ScvO_2明显降低(P0.05);与T_1时比较,T_4~T_6时S组VO2I明显升高(P0.05),T_3、T_4时ScvO_2明显降低(P0.05);T_4、T_5时S组DO_2I明显高于C组,T_3~T_6时S组VO2I,O_2ER及Lac水平明显低于C组,ScvO2明显高于C组(P0.05)。结论每搏变异度为导向液体治疗能够有效维持血流动力学稳定,增加机体氧供,降低氧耗,保证组织微循环灌注。

Effect of goal-directed fluid therapy on the oxygen delivery and consumption and tissue perfusion in pa-tients with continuous hyperthermic peritoneal perfusion

Objective To discuss the effects of the goal-directed fluid therapy on the haemody-namics,oxygen delivery and consumption and tissue perfusion in patients with continuous hyperther-mic peritoneal perfusion.Methods Eighty patients (61 males,19 females,aging from 30 to 60years old,ASA grade Ⅰ-Ⅲ)undergoing continuous hyperthermic peritoneal perfusion were selected and di-vided into 2 groups (n=40).Conventional liquid treatment group(group C)and Stroke Volume Vari-ation-directed liquid treatment group(group S).All patients were received general anesthesia and mo-nitored with FloTrac/Vigile systerm.MAP,HR,CVP,CI,PaO2 ,SaO2 ,PvO2 ,ScvO2 and Lac were all recorded in the time before anesthesia(T0 ),5 min after endotracheal intubation (T1 ),before CHPP (T2 ),CHPP for 30 min (T3 ),CHPP for 60 min (on the end,T4 ),30 min after CHPP (T5 ), and at the end of surgery (T6 ).According to the formula to calculate oxygen transport (DO2 I)and oxygen consumption index (VO2 I).Results Compared with group C,the amount of fluid, crystalloid solution,and urine volume were all much lower and colloidal solution was much higher in group S (P <0.05).Compared with T1 ,MAP decreased in the two groups at T3 and T4 ,yet HR in-creased and CVP decreased in group C at T4 (P <0.05).CVP increased in group C at T6 and in group S at T3-T5 .At the time points of T3 to T6 ,MAP and CI in group S were significantly higher than those in group C,while CVP and HR were much lower in group S (P <0.05).Compared with T1 , the DO2 I in group C were lower at T4 ,T5 (P <0.05),while VO2 I,O2 ER and Lac in group C in-creased at T3-T6 (P <0.05),also ScvO2 decreased at the same time (P <0.05).Compared with T1 , the VO2 I increased at T4-T6 ,but ScvO2 decreased at T3 ,T4 in group S (P <0.05).DO2 I in group S were higher than those in group C at T4 and T5 ,whereas,VO2 I,O2 ER and Lac level in group S were much lower than those in group C,and ScvO2 were significantly higher than those at T3-T6 in group C (P <0.05).Conclusion Stroke variation degree-oriented liquid treatment could effectively maintain hemodynamic stability,increase the body's oxygen supply,reduce oxygen consumption and improve tissue perfusion.