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脉压变异度指导下的目标导向液体治疗可降低老年腹腔镜结直肠癌根治术患者的术后并发症:一项随机对照试验

Pulse pressure variation guided goal-direct fluid therapy decreases postoperative complications in elderly patients undergoing laparoscopic radical resection of colorectal cancer: a randomized controlled trial.

作者信息

Wu Qiu-Rong, Zhao Zi-Zuo, Fan Ke-Ming, Cheng Hui-Ting, Wang Bin

机构信息

Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Department of Anesthesiology, Yongchuan District People's Hospital of Chongqing, Chongqing, 400016, China.

出版信息

Int J Colorectal Dis. 2024 Mar 4;39(1):33. doi: 10.1007/s00384-024-04606-x.

Abstract

OBJECTIVE

The use of goal-directed fluid therapy (GDFT) has been shown to reduce complications and improve prognosis in high-risk abdominal surgery patients. However, the utilization of pulse pressure variation (PPV) guided GDFT in laparoscopic surgery remains a subject of debate. We hypothesized that utilizing PPV guidance for GDFT would optimize short-term prognosis in elderly patients undergoing laparoscopic radical resection for colorectal cancer compared to conventional fluid therapy.

METHODS

Elderly patients undergoing laparoscopic radical resection of colorectal cancer were randomized to receive either PPV guided GDFT or conventional fluid therapy and explore whether PPV guided GDFT can optimize the short-term prognosis of elderly patients undergoing laparoscopic radical resection of colorectal cancer compared with conventional fluid therapy.

RESULTS

The incidence of complications was significantly lower in the PPV group compared to the control group (32.8% vs. 57.1%, P = .009). Additionally, the PPV group had a lower occurrence of gastrointestinal dysfunction (19.0% vs. 39.3%, P = .017) and postoperative pneumonia (8.6% vs. 23.2%, P = .033) than the control group.

CONCLUSION

Utilizing PPV as a monitoring index for GDFT can improve short-term prognosis in elderly patients undergoing laparoscopic radical resection of colorectal cancer.

REGISTRATION NUMBER

ChiCTR2300067361; date of registration: January 5, 2023.

摘要

目的

目标导向液体治疗(GDFT)已被证明可降低高危腹部手术患者的并发症发生率并改善预后。然而,在腹腔镜手术中使用脉压变异(PPV)引导的GDFT仍存在争议。我们假设,与传统液体治疗相比,在接受腹腔镜结直肠癌根治术的老年患者中,使用PPV引导的GDFT可优化短期预后。

方法

将接受腹腔镜结直肠癌根治术的老年患者随机分为接受PPV引导的GDFT组或传统液体治疗组,探讨与传统液体治疗相比,PPV引导的GDFT是否能优化接受腹腔镜结直肠癌根治术的老年患者的短期预后。

结果

与对照组相比,PPV组的并发症发生率显著更低(32.8%对57.1%,P = 0.009)。此外,PPV组的胃肠功能障碍发生率(19.0%对39.3%,P = 0.017)和术后肺炎发生率(8.6%对23.2%,P = 0.033)均低于对照组。

结论

将PPV用作GDFT的监测指标可改善接受腹腔镜结直肠癌根治术的老年患者的短期预后。

注册号

ChiCTR2300067361;注册日期:2023年1月5日。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bbf/10912221/2ce495d0df71/384_2024_4606_Fig1_HTML.jpg

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