基于血浆胶体渗透压的目标导向液体治疗对老年患者腹部大手术后肺部并发症的影响。

Effect of goal-directed fluid therapy based on plasma colloid osmotic pressure on the postoperative pulmonary complications of older patients undergoing major abdominal surgery.

机构信息

Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shanxi, China.

出版信息

World J Surg Oncol. 2023 Feb 28;21(1):67. doi: 10.1186/s12957-023-02955-5.

DOI:10.1186/s12957-023-02955-5

PMID:36849953

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9970856/

Abstract

BACKGROUND

As an important component of accelerated rehabilitation surgery, goal-directed fluid therapy (GDT) is one of the optimized fluid therapy strategies and is closely related to perioperative complications and mortality. This article aimed to study the effect of combining plasma colloid osmotic pressure (COP) with stroke volume variation (SVV) as a target for intraoperative GDT for postoperative pulmonary complications in older patients undergoing major abdominal surgery.

METHODS

In this study, older patients (n = 100) undergoing radical resection of gastroenteric tumors were randomized to three groups: Group C (n1 = 31) received a conventional infusion regimen, Group S1 (n2 = 34) received GDT based on SVV, and Group S2 (n3 = 35) received GDT based on SVV and COP. The results were recorded, including the lung injury score (LIS); PaO/FiO ratio; lactic acid value at the times of beginning (T0) and 1 h (T1), 2 h (T2), and 3 h (T3) after liquid infusion in the operation room; the total liquid infusion volume; infusion volumes of crystalline and colloidal liquids; urine production rate; pulmonary complications 7 days after surgery; and the severity grading of postoperative pulmonary complications.

RESULTS

The patients in the S2 group had fewer postoperative pulmonary complications than those in the C group (P < 0.05) and the proportion of pulmonary complications of grade 1 and higher than grade 2 in S2 group was significantly lower than that in C group (P <0.05); the patients in the S2 group had a higher PaO/FiO ratio than those in the C group (P < 0.05), lower LIS than those in the S1 and C groups (P < 0.05), less total liquid infusion than those in the C group (P < 0.05), and more colloidal fluid infusion than those in the S1 and C groups (P < 0.05).

CONCLUSION

The findings of our study show that intraoperative GDT based on COP and SVV can reduce the incidence of pulmonary complications and conducive to shortening the hospital stay in older patients after gastrointestinal surgery.

TRIAL REGISTRATION

Chinese Clinical Trial. no. ChiCTR2100045671. Registry at www.chictr.org.cn on April 20, 2021.

摘要

背景

作为加速康复外科的重要组成部分，目标导向液体治疗（GDT）是优化的液体治疗策略之一，与围手术期并发症和死亡率密切相关。本文旨在研究将血浆胶体渗透压（COP）与每搏变异度（SVV）结合作为指导术中 GDT 的目标，对老年胃肠肿瘤根治术患者术后肺部并发症的影响。

方法

本研究纳入 100 例行胃肠肿瘤根治术的老年患者，随机分为三组：C 组（n1=31）接受常规输液方案，S1 组（n2=34）接受基于 SVV 的 GDT，S2 组（n3=35）接受基于 SVV 和 COP 的 GDT。记录结果，包括肺损伤评分（LIS）、PaO/FiO 比值、手术室输液开始时（T0）和 1 小时（T1）、2 小时（T2）和 3 小时（T3）的血乳酸值、总输液量、晶体和胶体液体的输注量、尿量、术后 7 天肺部并发症发生率、术后肺部并发症严重程度分级。

结果

S2 组患者术后肺部并发症发生率低于 C 组（P<0.05），S2 组肺部并发症 1 级及以上的比例明显低于 C 组（P<0.05）；S2 组患者 PaO/FiO 比值高于 C 组（P<0.05），LIS 低于 S1 组和 C 组（P<0.05），总输液量少于 C 组（P<0.05），胶体液输注量多于 S1 组和 C 组（P<0.05）。