Evaluation of goal-directed fluid therapy after radical surgery in patients with thoracic malignant neoplasms

doi:10.3877/cma.j.issn.1674-6880.2017.03.008

Abstract

Abstract:

Objective

To investigate the value of goal-directed fluid therapy (GDFT) after radical surgery in patients with thoracic malignant neoplasms.

Methods

Totally 100 patients with malignant neoplasms underwent thoracic surgery were randomly divided to the control group and GDFT group, 50 patients in each group. Patients in the control group received routine fluid therapies, and patients in the GDFT group were given individually GDFT. The heart rates, mean arterial pressure (MAP), central venous pressure (CVP), cardiac index and stroke volume (SV) were detected at ICU (T1), 8 h (T2), 24 h (T3) after surgery. The incidence rates of hypovolemia, pulmonary edema and metabolic acidosis after surgery, length of ICU and hospital stay were recorded and compared between the two groups.

Results

The heart rates in the two groups showed no significant differences (F = 0.335, P = 0.564), and the MAP, CVP, cardiac index and SV all showed significant differences between the two groups (F = 7.905, P = 0.006; F = 76.563, P < 0.001; F = 378.906, P < 0.001; F = 267.969, P < 0.001), and MAP [(80 ± 9) mmHg vs. (68 ± 10) mmHg, (85 ± 11) mmHg vs. (76 ± 9) mmHg], CVP [(7.9 ± 2.8) cmH₂O vs. (4.6 ± 2.2) cmH₂O, (8.3 ± 3.0) cmH₂O vs. (5.7 ± 2.9) cmH₂O], cardiac index [(2.9 ± 0.4) L·min^-1·m^-2 vs. (2.2 ± 0.3) L·min^-1·m^-2, (3.1 ± 0.3) L·min^-1·m^-2 vs. (2.4 ± 0.3) L·min^-1·m^-2] and SV [(53 ± 11) mL vs. (49 ± 9) mL, (61 ± 10) mL vs. (48 ± 10) mL] in the GDFT group at T2, T3 were much higher than those in the control group (all P < 0.05). Compared with the control group, the incidence rates of hypovolemia were much lower [17/50 vs. 8/50, χ² = 5.869, P = 0.015], the length of ICU [(4.9 ± 2.7) d vs. (2.9 ± 1.8) d, t = 4.137, P < 0.001] and hospital stay [(22 ± 4) d vs. (17 ± 5) d, t = 4.660, P < 0.001] were much shorter in the GDFT group.

Conclusion

GDFT could significantly improve hemodynamic parameters and reduce the length of hospital stay, and be helpful to postoperative recovery of patients with thoracic malignant neoplasms.

Key words: Goal-directed fluid therapy, Thoracic neoplasms, Hemodynamics, Postoperative complications

Jian Huang, Kaizhong Liu, Wensheng Liu. Evaluation of goal-directed fluid therapy after radical surgery in patients with thoracic malignant neoplasms[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(03): 182-187.

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References 31

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组别	例数	男/女（例）	年龄（岁）	ASA分级（Ⅱ/Ⅲ）	BMI（kg/m²）	血红蛋白（g/L）	血小板计数（× 10⁹/L）	血肌酐（μmol/L）
对照组	50	26/24	57 ± 10	28/22	21.2 ± 3.2	117 ± 20	286 ± 82	66 ± 14
GDFT组	50	28/22	58 ± 9	32/18	20.8 ± 2.6	114 ± 21	260 ± 102	61 ± 15
t/χ²值	?	0.901	0.606	1.737	0.197	1.777	0.963	0.811
P值	?	0.343	0.545	0.188	0.844	0.078	0.337	0.423

组别	例数	男/女（例）	年龄（岁）	ASA分级（Ⅱ/Ⅲ）	BMI（kg/m²）	血红蛋白（g/L）	血小板计数（× 10⁹/L）	血肌酐（μmol/L）
对照组	50	26/24	57 ± 10	28/22	21.2 ± 3.2	117 ± 20	286 ± 82	66 ± 14
GDFT组	50	28/22	58 ± 9	32/18	20.8 ± 2.6	114 ± 21	260 ± 102	61 ± 15
t/χ²值	?	0.901	0.606	1.737	0.197	1.777	0.963	0.811
P值	?	0.343	0.545	0.188	0.844	0.078	0.337	0.423

组别	例数	时点	心率（次/min）	MAP（mmHg）	CVP（cmH₂O）	心脏指数（L·min^-1·m^-2）	SV（mL）
?	?	T1	90 ± 10	84 ± 9	5.4 ± 2.1	2.8 ± 0.4	53 ± 10
对照组	50	T2	103 ± 11	68 ± 10^a	4.6 ± 2.2^a	2.2 ± 0.3^a	49 ± 9
?	?	T3	99 ± 12	76 ± 9^b	5.7 ± 2.9^b	2.4 ± 0.3^a	48 ± 10^a
?	?	T1	88 ± 11	86 ± 10	5.5 ± 2.2	2.7 ± 0.5	54 ± 9
GDFT组	50	T2	97 ± 12	80 ± 9^ac	7.9 ± 2.8^ac	2.9 ± 0.4^c	53 ± 11^d
?	?	T3	92 ± 10	85 ± 11^bc	8.3 ± 3.0^ac	3.1 ± 0.3^ac	61 ± 10^abc
F值	?	?	0.335	7.905	76.563	378.906	267.969
P值	?	?	0.564	0.006	<0.001	<0.001	<0.001

组别	例数	时点	心率（次/min）	MAP（mmHg）	CVP（cmH₂O）	心脏指数（L·min^-1·m^-2）	SV（mL）
?	?	T1	90 ± 10	84 ± 9	5.4 ± 2.1	2.8 ± 0.4	53 ± 10
对照组	50	T2	103 ± 11	68 ± 10^a	4.6 ± 2.2^a	2.2 ± 0.3^a	49 ± 9
?	?	T3	99 ± 12	76 ± 9^b	5.7 ± 2.9^b	2.4 ± 0.3^a	48 ± 10^a
?	?	T1	88 ± 11	86 ± 10	5.5 ± 2.2	2.7 ± 0.5	54 ± 9
GDFT组	50	T2	97 ± 12	80 ± 9^ac	7.9 ± 2.8^ac	2.9 ± 0.4^c	53 ± 11^d
?	?	T3	92 ± 10	85 ± 11^bc	8.3 ± 3.0^ac	3.1 ± 0.3^ac	61 ± 10^abc
F值	?	?	0.335	7.905	76.563	378.906	267.969
P值	?	?	0.564	0.006	<0.001	<0.001	<0.001

组别	例数	低血容量[例（%）]	肺水肿[例（%）]	代谢性酸中毒[例（%）]	ICU住院时间（d）	总住院时间（d）
对照组	50	17（34）	4（8）	14（28）	4.9 ± 2.7	22 ± 4
GDFT组	50	8（16）	3（6）	13（26）	2.9 ± 1.8	17 ± 5
t/χ²值	?	5.869	0.455	0.034	4.137	4.660
P值	?	0.015	0.455	0.854	<0.001	<0.001

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