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分阶段目标导向液体治疗对接受McKeown食管切除术患者术后肺部并发症的影响：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：田明德 编辑：田明德 审校：曹莹
背景：我们的目的是评估分期目标导向治疗(GDT)对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，分阶段GDT组(A组，n = 56):单肺通气(OLV)期每搏量变化度(SVV)设定为8-10%，双肺通气(TLV)期设定为8-12%;GDT组(B组，n = 56):在整个手术过程中接受目标SVV为8-12%的GDT治疗;对照组(C组，n = 56):通过平均动脉压(MAP)、中心静脉压(CVP)和尿量进行常规液体治疗。主要观察指标为术后肺并发症(POD)的发生率。次要观察指标为术后肺超声(LUS) b线人工智能(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)、心脏指数(CI)、心输出量(CO)、氧合指数(OI)、呼吸指数(RI)、肺泡-动脉血氧差(Aa-DO2)。
结果：与C组相比，A组和B组的PPC发生率较低（7/56 vs.17/56和9/56 vs.17/56，p<0.05），术后超声B线评分较低（4.61±0.51 vs.6.15±0.74和4.75±0.62 vs.6.11±0.74，p<0.05）。在胸部手术阶段，A组的CI、CO、MAP和OI高于B组和C组。在腹部手术阶段，A组和B组的血流动力学和氧合指标均优于C组。
Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial
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.
Method: 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-DO2).
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.
Conclusion: 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.
