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摘要：
目的 探讨目标导向液体治疗（goal⁃directed fluid therapy, GDFT）对老年腹腔镜结直肠癌手术患者多糖包被的影响。 方法 择期拟行结直肠癌根治术的患者50例，年龄60~85岁，ASA分级Ⅱ、Ⅲ级，依据随机数字表法分为2组（每组25例）：对照组（C组），维持MAP 65~90 mmHg（1 mmHg=0.133 kPa），尿量>0.5 ml·kg−1·h−1；目标导向液体治疗组（G组），实施GDFT，维持每搏量变异度（stroke volume variability, SVV）<13%、心指数（cardiac index, CI）>2.5 L·min−1·m−2。分别于入室（T0）、手术开始1 h（T1）和术毕（T2）记录心率、MAP、CVP，并于上述时点检测多配体聚糖1（syndecan⁃1, SDC⁃1）、硫酸乙酰肝素（heparan sulfate, HS）和TNF⁃α浓度，记录术中液体出入量、血管活性药物应用、术后首次排气时间、住院时间及并发症发生情况。 结果 与T0比较，两组T1和T2时点SDC⁃1、HS和TNF⁃α浓度升高（P<0.05）。与C组比较，G组T1和T2时点CVP降低，T2时点SDC⁃1、HS和TNF⁃α浓度降低，总输液量、晶体液用量和胶体液用量减少，术后首次排气时间缩短（均P<0.05）。 结论 老年患者行腹腔镜结直肠癌根治术中以SVV和CI为指导的GDFT可维持合理容量水平，减轻术中全身炎症反应，减少血管内皮多糖包被的降解。
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Abstract: Objective To explore the effect of goal⁃directed fluid therapy (GDFT) on the glycocalyx in elderly patients undergoing laparoscopic colorectal cancer surgery. Methods A total of 50 patients, aged 60−85 years, American Society of Anesthesiologists physical status Ⅱ or Ⅲ, who were scheduled for laparoscopic colorectal cancer surgery were enrolled. According to the random number table method, they were divided into two groups (n=25): a control group (group C) and a GDFT group (group G). In group C, mean arterial pressure (MAP) was maintained at 65−90 mmHg (1 mmHg=0.133 kPa), with urine volume>0.5 ml·kg−1·h−1. In group G, GDFT was performed, while stroke volume variation<13% and cardiac index>2.5 L·min−1·m−2 were maintained. Their heart rate, MAP, and central venous pressure (CVP) were recorded immediately before the patients entered the operating room (T0), 1 h after the beginning of operation (T1) and at the end of operation (T2). The concentrations of syndecan⁃1 (SDC⁃1), heparan sulfate (HS) and tumor necrosis factor⁃alpha (TNF⁃α) were detected at T0−T2. Furthermore, their intraoperative fluid infusion volume, the usage of vasoactive drugs, the first exhaust time, the length of hospitalization stay and postoperative complications were recorded. Results Compared with those at T0, the levels of SDC⁃1, HS and TNF⁃α increased in the two groups at T1 and T2 (P<0.05). Compared with group C, group G showed decreases in CVP at T1 and T2, decreases in SDC⁃1, HS and TNF⁃α at T2, reduction in total volume, crystal volume and the amount of colloid solution, and shortened first exhaust time (P<0.05). Conclusions GDFT guided by SVV and CI during laparoscopic colorectal cancer surgery in elderly patients can maintain a reasonable volume level, relieve intraoperative systemic inflammatory response, and reduce the degradation of vascular endothelial glycocalyx.
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