Department of Anesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Radiol Oncol. 2024 Mar 7;58(2):279-288. doi: 10.2478/raon-2024-0015. eCollection 2024 Jun 1.
Intraoperative fluid management is a crucial aspect of cancer surgery, including colorectal surgery and pancreatoduodenectomy. The study tests if intraoperative multimodal monitoring reduces postoperative morbidity and duration of hospitalisation in patients undergoing major abdominal surgery treated by the same anaesthetic protocols with epidural analgesia.
A prospective study was conducted in 2 parallel groups. High-risk surgical patients undergoing major abdominal surgery were randomly selected in the control group (CG), where standard monitoring was applied (44 patients), and the protocol group (PG), where cerebral oxygenation and extended hemodynamic monitoring were used with the protocol for intraoperative interventions (44 patients).
There were no differences in the median length of hospital stay, CG 9 days (interquartile range [IQR] 8 days), PG 9 (5.5), p = 0.851. There was no difference in postoperative renal of cardiac impairment. Procalcitonin was significantly higher (highest postoperative value in the first 3 days) in CG, 0.75 mcg/L (IQR 3.19 mcg/L), than in PG, 0.3 mcg/L (0.88 mcg/L), p = 0.001. PG patients received a larger volume of intraoperative fluid; median intraoperative fluid balance +1300 ml (IQR 1063 ml) than CG; +375 ml (IQR 438 ml), p < 0.001.
There were significant differences in intraoperative fluid management and vasopressor use. The median postoperative value of procalcitonin was significantly higher in CG, suggesting differences in immune response to tissue trauma in different intraoperative fluid status, but there was no difference in postoperative morbidity or hospital stay.
术中液体管理是癌症手术（包括结直肠手术和胰十二指肠切除术）的关键环节。本研究旨在测试在接受相同硬膜外镇痛麻醉方案治疗的高危手术患者中，术中多模态监测是否能降低主要腹部手术后的术后发病率和住院时间。
在 2 个平行组中进行了前瞻性研究。在对照组（CG）中随机选择接受主要腹部手术的高风险手术患者，应用标准监测（44 例），而在方案组（PG）中则采用脑氧合和扩展血流动力学监测，并根据术中干预方案进行监测（44 例）。
中位住院时间无差异，CG 为 9 天（四分位距 [IQR] 8 天），PG 为 9（5.5），p=0.851。术后肾功能和心功能障碍无差异。CG 的降钙素原显著升高（前 3 天的最高术后值），为 0.75 mcg/L（IQR 3.19 mcg/L），而 PG 为 0.3 mcg/L（0.88 mcg/L），p=0.001。PG 患者术中液体输注量更大；术中液体平衡中位数为+1300 ml（IQR 1063 ml），CG 为+375 ml（IQR 438 ml），p<0.001。
术中液体管理和血管加压药使用存在显著差异。CG 术后降钙素原的中位值显著升高，提示不同术中液体状态下对组织创伤的免疫反应存在差异，但术后发病率和住院时间无差异。
