| Objective The objective of the study was to discuss the influence of goal-directed liquid treatment for prognosis of the gastrointestinal tumor patients and the inflammatory cytokines during the perioperative period in patients by comparing with the traditional way of fluid infusion and observing the patients TNF-α, IL-6 concentration changes during the perioperative period.Methods From December 2014 to June 2015, a total of 60 patients(49~80 years old) from the All Rights Reserved by North China University of Science and Technology Affiliated hospital who was classified as American Society of Anesthesiology(ASA) class I~Ⅱand underwent Gastrointestinal tumor surgery, were randomly divided into two groups base on treatment by computer: goal-directed fluid therapy(group S) and central venous pressure liquid management(group C),each group has 30 patients. Group S using of Flotrac/Vigileo monitoring system would served 10%≤SVV≤12% as a target for goal-directed fluid therapy, group C using CVP to keep 8~12cm H2 O and using MAP to keep 60~100mm Hg for fluid management. All the operations were done by the same surgeon team, and all the cases were introduced general anesthesia and trachea intubation. Patients were routinely monitored the hemodynamic changes, crystal liquid usage amount, colloid liquid usage amount,Intraoperative supplement of liquid volume,urine volume, the lost blood volume as a result of the surgery, the incidence of postoperative complications associated, the postoperative hospitalization days, the exhaust time and the time of full or semi-liquid diet.The BP, HR, CVP were monitored and recorded before anesthesia(T0), the beginning of surgery(T1),one hour after surgery(T2), two hours after surgery(T3), at the end of operation(T4). We obtained a blood sample for evaluation of TNF-α, IL-6 from each patient two milliliter. All samples were obtained before anesthesia(T0), the end of surgery(T4), 6h(T5) after the surgery, 12h(T6) after the surgery, 24h(T7) after the surgery.Results A total of 55 cases were included in the research with 5 cases excluded for changing operation mode. There were 27 cases in group S and 28 cases in group C. No difference was observed in age, gender, BMI, ASA, type of diseases and surgery between these two groups, neither in operative time, blood loss, urine output and the transfusion of red blood cells, plasma ratio(P>0.05). But less infusion volume and colloid was needed in group S than group C(P<0.05). No difference was observed in MAP, HR, Sp O2 between group S and group C, but in T3, group S higher than group C for the CVP(P<0.05). There was no difference neither Hb nor Hct(P>0.05). Pulling out the endotracheal tube time of postoperative anal exhaust time were earlier than(P<0.05). The time of full-1iquid diet,length of stay in hospital were group S under group C, however leaving bed activity time and incidence of complications were no statistically significant difference(P>0.05). Before operation, there was no statistically significant difference compared two kinds of inflammatory cytokines. The levels of TNF-α in S group were lower than that in C group at 24 hours after operation(P<0.05). The levels of IL-6 in S group were lower than that in C group at the rest hours after operation(P<0.05)except the 12 h after operation(P>0.05).Conclusions 1) Under the equal effect, goal-directed fluid therapy could reduce the demand of colloid, the intraoperative fluid infusion obviously for the patients undergoing gastrointestinal tumor surgery. It could better improve the microcirculation and tissue oxygen supply, at the same time, it could reduce the incidence of postoperative corresponding complications and it could restore intestinal function much earlier. 2) Under the equal effect, GDFT could help relieve the inflammation of the gastrointestinal tract cancer patients and could speed up the disappearing and the recovery of the postoperative inflammation. |
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