摘要
目的 探讨麻醉手术期间分阶段目标导向液体治疗(GDFT)对肺癌根治术患者组织灌注及认知功能的影响.方法 前瞻性选取108例肺癌患者,应用随机数字表法分为对照组和研究组,对照组患者给予经典的限制性液体疗法,研究组患者给予分阶段GDFT.比较两组患者的手术时间、术中出血量、胶体液用量、晶体液用量、总输出量和尿量;比较两组患者麻醉诱导前(T0)、单肺通气前(T1)、单肺通气1 h(T2)、恢复双肺通气即刻(T3)、双肺通气30 min(T4)、术毕(T5)的氧合指数(OI)、呼吸指数(RI)、中心静脉氧饱和度(ScvO2)、乳酸(Lac)、中心静脉-动脉血二氧化碳分压差(Pcv-aCO2)、氧供指数(DO2I)和氧摄取率(O2ERe);采用简易智力状态检查量表(MMSE)评价两组患者术前1 d,术后1、3 d的认知功能评分,同时记录术后3 d内认知功能障碍(POCD)和肺部并发症(包括肺部感染、急性肺损伤、肺栓塞、肺水肿、肺不张等)发生率.结果 研究组晶体液用量、尿量明显少于对照组,胶体液用量明显多于对照组(均P＜0.05).研究组T,～T5的OI均显著高于对照组,T2～T5的RI显著低于对照组(均P＜0.05).研究组T1～T5的ScvO2均显著高于对照组,Lac明显低于对照组(均P＜0.05);两组患者术后1、3 d的MMSE评分均显著低于术前1 d,且研究组患者术后1、3 d MMSE评分均显著高于对照组(均P＜0.05).研究组术后3 d内POCD发生率为16.67％(9/54),低于对照组的37.04％(20/54)(x2=5.704,P=0.017);研究组患者肺部并发症发生率低于对照组(5.56％vs22.22％,x2=4.955,P=0.026).结论 肺癌根治术患者麻醉期间应用分阶段GDFT相比常规液体治疗能进一步提高组织灌注,改善患者微循环和包括脑在内的全身器官组织的氧供需平衡,减轻围术期脑功能损伤,减少术后POCD的发生.
Abstract
Objective To explore the effects of phased goal directed fluid therapy(GDFT)during anesthesia surgery on tissue perfusion and cognitive function in patients undergoing radical lung cancer surgery.Methods A total of 108 lung cancer patients were prospectively selected and randomly divided into a control group and a study group using a random number table method.The control group received classical restrictive liquid therapy,while the study group received staged GDFT.We compared the surgical time,intraoperative blood loss,colloid fluid dosage,crystalloid fluid dosage,total output,and urine volume between two groups of patients;Two groups of patients were compared in terms of oxygenation index(OI),respiratory index(RI),central venous oxygen saturation(ScvO2),lactate(Lac),central venous arterial carbon dioxide partial pressure difference(Pcv-aCO2),oxygen supply index(DO2I),and oxygen uptake rate(O2ERe)before anesthesia induction(T0),before single lung ventilation(T,),1 hour of single lung ventilation(T2),immediate resumption of dual lung ventilation(T3),30 minutes of dual lung ventilation(T4),and after surgery(T5);The Mini Mental State Examination(MMSE)was used to evaluate the cognitive function scores of two groups of patients 1 day before surgery and 1 and 3 days after surgery,while recording the incidence of cognitive dysfunction(POCD)and pulmonary complications(including pulmonary infection,acute lung injury,pulmonary embolism,pulmonary edema,atelectasis,etc.)within 3 days after surgery.Results The amount of crystal fluid and urine output in the research group was significantly lower than that in the control group,while the amount of colloidal fluid was significantly higher than that in the control group(all P＜0.05).The OI of the study group T1-T5 was significantly higher than that of the control group,while the RI of T2-T5 was significantly lower than that of the control group(all P＜0.05).The ScvO2 of the study group T1 to T5 was significantly higher than that of the control group,and the Lac was significantly lower than that of the control group(all P＜0.05);The MMSE scores of both groups of patients were significantly lower than those before surgery on day 1 and 3 after surgery,and the MMSE scores of the study group were significantly higher than those of the control group on day 1 and 3 after surgery(all P＜0.05).The incidence of POCD within 3 days after surgery in the study group was 16.67％(9/54),lower than 37.04％(20/54)in the control group(x2=5.704,P=0.017);The incidence of pulmonary complications in the study group was lower than that in the control group(5.56％vs 22.22％,x2=4.955,P=0.026).Conclusions The application of staged GDFT during anesthesia in patients undergoing radical lung cancer surgery can further improve tissue perfusion,improve microcirculation and oxygen supply-demand balance of systemic organs and tissues,including the brain,alleviate perioperative brain function damage,and reduce the occurrence of postoperative POCD compared to conventional liquid therapy.
基金项目
河北省卫生健康委医学课题计划项目(20210385)
维普
万方数据