目标导向液体管理对胃肠道肿瘤患者炎性细胞因子和预后的影响
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摘要
目的探讨目标导向液体管理对胃肠道肿瘤患者围术期内炎性细胞因子的影响。方法选择择期胃肠道肿瘤手术的患者40例,随机分为目标导向液体管理组(S组)和中心静脉压液体管理组(C组)。记录术后住院时间、排气时间、进食流食时间、晶体液量、胶体液量、液体总量、尿量及出血量。记录术前(T0)、手术开始(T1)、手术1 h(T2)、手术2 h(T3)、术毕(T4)的血压(BP)、心率(HR)、中心静脉压(CVP)等情况。分别抽取T0、T2、T4、术后24 h(T5)中心静脉血2 m L,血样用于测定血清TNF-α、IL-6的浓度。结果 2组患者术后排气时间、进食半流食时间、住院时间比较有显著差异。S组T3时CVP显著高于C组(P<0.05)。术毕到术后24 h,S组血清TNF-α和IL-6水平显著低于C组(P<0.05)。结论利用目标导向液体管理可以减轻胃肠道肿瘤患者术后炎症应激反应。
Objective To explore the influence of goal-directed fluid management on the inflammatory cytokines in the perioperative period in patients with gastrointestinal cancer. Methods A total of 40 patients underwent gastrointestinal tumor surgery were randomly divided into goal-directed fluid management group( group S) and central venous pressure liquid management group( group C).Postoperative hospital stay,defecation and exhaust time,the time of eating semi-liquid diet,crystalloid requirements,colloid requirements,total liquid,urinary output and bleeding volume were recorded.The BP,HR,CVP were monitored and recorded at the time points of before anesthesia( T0),the beginning of surgery( T1),one hour after the starting of surgery( T2),two hours after the starting of surgery( T3) and end of operation( T4). Authors obtained a 3 m L blood sample for evaluation of TNF-α,IL-6. All samples were obtained at the time points of before anesthesia( T0),the end of surgery( T4),24 h after the surgery( T5),48 h after the surgery( T6). Results There were significant differences in time of eating semi-liquid diet,the postoperative hospital stays and the time of defecation and exhaust between two groups. CVP level at T3 in group S was significantly higher than that in group C( P < 0. 05). The levels of IL-6 and TNF-in group S were significantly lower than those in group C from end of operation to 24 h after operation( P < 0. 05). Conclusion Goal-directed fluid management can alleviate the reaction of inflammatory cytokines of the patients with gastrointestinal tumor surgery.
Objective To explore the influence of goal-directed fluid management on the inflammatory cytokines in the perioperative period in patients with gastrointestinal cancer. Methods A total of 40 patients underwent gastrointestinal tumor surgery were randomly divided into goal-directed fluid management group( group S) and central venous pressure liquid management group( group C).Postoperative hospital stay,defecation and exhaust time,the time of eating semi-liquid diet,crystalloid requirements,colloid requirements,total liquid,urinary output and bleeding volume were recorded.The BP,HR,CVP were monitored and recorded at the time points of before anesthesia( T0),the beginning of surgery( T1),one hour after the starting of surgery( T2),two hours after the starting of surgery( T3) and end of operation( T4). Authors obtained a 3 m L blood sample for evaluation of TNF-α,IL-6. All samples were obtained at the time points of before anesthesia( T0),the end of surgery( T4),24 h after the surgery( T5),48 h after the surgery( T6). Results There were significant differences in time of eating semi-liquid diet,the postoperative hospital stays and the time of defecation and exhaust between two groups. CVP level at T3 in group S was significantly higher than that in group C( P < 0. 05). The levels of IL-6 and TNF-in group S were significantly lower than those in group C from end of operation to 24 h after operation( P < 0. 05). Conclusion Goal-directed fluid management can alleviate the reaction of inflammatory cytokines of the patients with gastrointestinal tumor surgery.
引文
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[13]骆永春,唐大年,周雪,等.老年胃肠道肿瘤住院患者营养风险筛查和营养支持调查分析[J].中华老年医学杂志,2014,33(1):85-87.
[14]李德育,崔同建,刘振华.肿瘤内科老年住院患者营养风险筛查和营养支持状况分析[J].吉林医学,2012,33(30):6607-6607.
[15]黄正接,陈百胜,尤俊,等.胃肠道恶性肿瘤术前肠内免疫营养支持的临床意义[J].四川大学学报:医学版,2014,45(01):167-170.
[16]李帅军,刘欣.胃肠道恶性肿瘤围术期肠内免疫营养对术后免疫功能的影响[J].实用临床医药杂志,2012,16(17):46-48.
[2]赵玉沛,杨尹默,楼文晖,等.外科病人围术期液体治疗专家共识(2015)[J].中国实用外科杂志,2015,35(9):960-966.
[3]P-G G,Urbina B,Broca B D,et al.Predictability of the respiratory variation of stroke volume varies according to the definition of fluid responsiveness[J].Bja British Journal of Anaesthesia,2014,112(3):580-591.
[4]赵国良,周银燕,彭沛华,等.目标导向液体治疗对胃肠道肿瘤手术老年患者术后康复的影响[J].中华麻醉学杂志,2015,35(4):31-32.
[5]Challand C,Struthers R,Sneyd J R,et al.Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery[J].Bja British Journal of Anaesthesia,2012,108(108):53-62.
[6]Yu D,Chai W,Sun X,et al.The effect of body position changes on stroke volume variation in 66 mechanically ventilated patients with sepsis[J].Journal of Critical Care,2012,27(4):7-12.
[7]Tomas C,Rhodes J E J,Sarah C,et al.Perioperative fluid management strategies in major surgery:a stratified meta-analysis[J].Anesthesia&Analgesia,2012,114(3):640-651.
[8]李天佐.围术期麻醉管理与术后感染[J].北京医学,2014(8):19-20.
[9]Novitsky Y W,Litwin D E M,Callery M P.The net immunologic advantage of laparoscopic surgery[J].Surgical Endoscopy,2004,18(10):1411-1419.
[10]Foldi V,Lantos J,Bogar L.et al.Effects of fluid resuscitation methods on the pro-and anti-inflammatory cytokines and expression of adhesion molecules after burn injury[J].Journal of Burn Care&Research Official Publication of the American Burn Association,2010,31(3):480-491.
[11]李竟长,倪秉强,蒋志雄,等.肠外营养支持治疗对围化疗期晚期胃肠道肿瘤患者营养状况及免疫功能的影响[J].实用临床医药杂志,2014,18(5):20-23.
[12]马纯雪,徐晓琼,黄仁微.胃肠道肿瘤患者营养风险筛查特点及其对术后并发症的影响[J].中华全科医学,2014,12(12):1902-1904.
[13]骆永春,唐大年,周雪,等.老年胃肠道肿瘤住院患者营养风险筛查和营养支持调查分析[J].中华老年医学杂志,2014,33(1):85-87.
[14]李德育,崔同建,刘振华.肿瘤内科老年住院患者营养风险筛查和营养支持状况分析[J].吉林医学,2012,33(30):6607-6607.
[15]黄正接,陈百胜,尤俊,等.胃肠道恶性肿瘤术前肠内免疫营养支持的临床意义[J].四川大学学报:医学版,2014,45(01):167-170.
[16]李帅军,刘欣.胃肠道恶性肿瘤围术期肠内免疫营养对术后免疫功能的影响[J].实用临床医药杂志,2012,16(17):46-48.