Yu Jiawen, Che Lu, Zhu Afang, Xu Li, Huang Yuguang
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2022 Apr 6;12:833273. doi: 10.3389/fonc.2022.833273. eCollection 2022.
Fluid management during major gynecologic oncology surgeries faces great challenges due to the distinctive characteristics of patients with gynecologic malignancies as well as features of the surgical procedure. Intraoperative goal-directed fluid therapy (GDFT) has been proven to be effective in reducing postoperative complications among major colorectal surgeries; however, the efficacy of GDFT has not been fully studied in gynecologic malignancy surgeries. This study aimed to discuss the influence of GDFT practice in patients undergoing major gynecologic oncology surgery.
This study was a controlled before-and-after study. From June 2015 to June 2018 in Peking Union Medical College Hospital, a total of 300 patients scheduled for elective laparotomy of gynecological malignancies were enrolled and chronologically allocated into two groups, with the earlier 150 patients in the control group and the latter 150 patients in the GDFT group. The GDFT protocol was applied by Vigileo/FloTrac monitoring of stroke volume and fluid responsiveness to guide intraoperative fluid infusion and the use of vasoactive agents. The primary outcome was postoperative complications within 30 days after surgery. The secondary outcome included length of stay and time of functional recovery.
A total of 249 patients undergoing major gynecologic oncology surgery were analyzed in the study, with 129 in the control group and 120 patients in the GDFT group. Patients in the GDFT group had higher ASA classifications and more baseline comorbidities. GDFT patients received significantly less fluid infusion than the control group (15.8 vs. 17.9 ml/kg/h), while fluid loss was similar (6.9 vs. 7.1 ml/kg/h). GDFT was associated with decreased risk of postoperative complications (OR = 0.572, 95% CI 0.343 to 0.953, = 0.032), especially surgical site infections (OR = 0.127, 95% CI 0.003 to 0.971, = 0.037). The postoperative bowel function recovery and length of hospital stay were not significantly different between the two groups.
Goal-directed intraoperative fluid therapy is associated with fewer postoperative complications in patients undergoing major gynecologic oncology surgery.
由于妇科恶性肿瘤患者的独特特征以及手术过程的特点，妇科肿瘤大手术中的液体管理面临巨大挑战。术中目标导向液体治疗（GDFT）已被证明可有效减少结直肠大手术的术后并发症；然而，GDFT在妇科恶性肿瘤手术中的疗效尚未得到充分研究。本研究旨在探讨GDFT在妇科肿瘤大手术患者中的影响。
本研究为前后对照研究。2015年6月至2018年6月在北京协和医院，共有300例计划进行妇科恶性肿瘤择期剖腹手术的患者入组，并按时间顺序分为两组，较早的150例患者为对照组，后150例患者为GDFT组。通过Vigileo/FloTrac监测每搏量和液体反应性来应用GDFT方案，以指导术中液体输注和血管活性药物的使用。主要结局是术后30天内的术后并发症。次要结局包括住院时间和功能恢复时间。
本研究共分析了249例接受妇科肿瘤大手术的患者，其中对照组129例，GDFT组120例。GDFT组患者的ASA分级更高，基线合并症更多。GDFT组患者的液体输注量明显少于对照组（15.8 vs. 17.9 ml/kg/h），而液体丢失量相似（6.9 vs. 7.1 ml/kg/h）。GDFT与术后并发症风险降低相关（OR = 0.572，95%CI 0.343至0.953，P = 0.032），尤其是手术部位感染（OR = 0.127，95%CI 0.003至0.971，P = 0.037）。两组术后肠功能恢复和住院时间无显著差异。
目标导向的术中液体治疗与妇科肿瘤大手术患者术后并发症减少相关。
