分期目标导向液体治疗对 McKeown 食管癌切除术患者术后肺部并发症的影响：一项随机对照试验。

Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial.

机构信息

Graduate School of Bengbu Medical College, Bengbu, Anhui, 233004, People's Republic of China.

Department of Anesthesiology, The First Affiliated Hospital of the University of Science and Technology of China, South District, No. 1 Tian'ehu Street, Hefei, 236001, China.

出版信息

BMC Anesthesiol. 2024 Sep 17;24(1):330. doi: 10.1186/s12871-024-02719-y.

DOI:10.1186/s12871-024-02719-y

PMID:39289608

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11406780/

Abstract

BACKGROUND

Our aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy.

METHODS

Patients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8-10% during the one lung ventilation (OLV) stage and 8-12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8-12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO).

RESULTS

Patients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C.

CONCLUSIONS

In comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598).

摘要

背景

我们旨在评估分期目标导向治疗（GDT）对行 McKeown 食管切除术患者术后肺部并发症（PPCs）、术中血流动力学和氧合的影响。

方法

患者随机分为三组，分期 GDT 组（A 组，n=56）：单肺通气（OLV）阶段 SVV 设定为 8-10%，双肺通气（TLV）阶段 SVV 设定为 8-12%；GDT 组（B 组，n=56）：整个手术过程中接受目标 SVV 为 8-12%的 GDT；对照组（C 组，n=56）：通过平均动脉压（MAP）、中心静脉压（CVP）和尿量给予常规液体治疗。主要结局为术后 7 天内的术后肺部并发症发生率。次要结局包括术后肺部超声（LUS）B 线 artefacts（BLA）评分、其他并发症发生率、住院时间、术中血流动力学和氧合指标，包括平均动脉压（MAP）、心率（HR）、心指数（CI）、心输出量（CO）、氧合指数（OI）、呼吸指数（RI）、肺泡-动脉氧差（Aa-DO）。

结果

A 组和 B 组患者 PPCs 的发生率较低（7/56 比 17/56 和 9/56 比 17/56，p<0.05），术后超声 B 线评分较低（4.61±0.51 比 6.15±0.74 和 4.75±0.62 比 6.15±0.74，p<0.05）。与 B 组和 C 组相比，A 组患者在胸部手术阶段的 CI、CO、MAP 和 OI 更高。在腹部手术阶段，A 组和 B 组患者的血流动力学和氧合指标均优于 C 组。