Rankovic Vitomir I, Masirevic Vesna P, Pavlov Maja J, Ceranic Miljan S, Milenkovic Marija G, Simic Aleksandar P, Kecmanovic Dragutin M
First Surgical University Hospital, Institute for Digestive Diseases, Clinical Center of Serbia, Belgrade, Serbia.
Hepatogastroenterology. 2007 Mar;54(74):364-6.
BACKGROUND/AIMS: Cytoreductive surgery and hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) significantly improves patients survival with peritoneal carcinomatosis especially in low-grade tumor e.g. ovarian and appendiceal adenocarcinoma, peritoneal pseudomyxoma and grade I gastric and colorectal cancer.
During a period of nine years, hemodynamic and cardiac functions combined with urinary output during hyperthermic intraoperative intraperitoneal chemotherapy were prospectively measured in 60 patients.
Statistically significant hemodynamic and cardiac parameters were characterized by an increased heart rate and cardiac output as well as decreased systemic vascular resistance associated with an increased body temperature and decreased effective circulating volume. The tendency of urinary output was to decrease as the therapy progressed.
HIPEC induces a hyperdynamic circulatory state requiring increased intravenous fluid administration, which avoids changes because of increased intra-abdominal pressure. Documented by normal blood pressure and adequate urinary output hemodynamic and intravenous fluids, titrated to frequent urinary output determination, can achieve cardiac stability.
背景/目的：细胞减灭术及围手术期腹腔内热灌注化疗（HIPEC）显著提高了腹膜癌患者的生存率，尤其是对于低级别肿瘤，如卵巢癌和阑尾腺癌、腹膜假黏液瘤以及I级胃癌和结直肠癌。
在九年的时间里，对60例患者在术中腹腔内热化疗期间的血流动力学和心脏功能以及尿量进行了前瞻性测量。
具有统计学意义的血流动力学和心脏参数表现为心率和心输出量增加，全身血管阻力降低，同时体温升高，有效循环血量减少。随着治疗的进行，尿量有减少的趋势。
HIPEC会诱发高动力循环状态，需要增加静脉输液量，以避免因腹腔内压力升高而产生变化。通过正常血压和充足尿量证明，根据频繁的尿量测定进行血流动力学和静脉输液量的滴定，可以实现心脏稳定。
