Analysis Of Related Factors Influencing Perfusion Effect Of Perfusion Fluid Velocity During Intraperitoneal Hyperthermic Perfusion Chemotherapy

ObjectTo study and analyze the difference of short-term therapeutic effect and adverse reactions in the process of intraperitoneal hyperthermic perfusion chemotherapy(HIPEC)under different flow rates,as well as the drug utilization rate of cisplatin in intraperitoneal chemotherapy,and analyze the reasons that affect the therapeutic effect of HIPEC.Methods60 patients with stage III ovarian cancer treated with HIPEC after CRS in our hospital from June 2019 to November 2019 were included.The tolerable flow rate,perfusion times,and temperature difference of perfusion fluid in and out of HIPEC were observed and recorded,and the influence of flow rate on these parameters was studied.According to the tolerable flow rate,the patients were divided into high flow rate group and low flow rate group according to the average value.The difference of adverse reactions was evaluated according to the liver and kidney injury,gastrointestinal tract and postoperative pain of the two groups during hospitalization.After more than half a year of follow-up,the short-term efficacy of the two groups was evaluated according to the solid tumor evaluation standard Recest1.1.During the period of HIPEC,the content of platinum(PT)in perfusion solution was determined by inductively coupled plasma mass spectrometry(ICP-MS).The content of cisplatin in perfusion fluid after HIPEC was calculated,and the effect of flow rate on perfusion temperature and drug absorption was analyzed.All data were analyzed or plotted by SPSS.25 and Graphpad prism 8.3 software.Results1.The lowest flow rate was 100 ml/min,the highest was 416.7 ml/min,and the median flow rate was 213.3 ml/min.The patients were divided into two groups according to the median flow rate,and the low flow rate group was<213.3ml/min.The high flow rate group was≥213.3ml/min.The average flow rate of low flow rate group was 169±40.39ml/min,and that of high flow rate group was 314.2±155.56ml/min.2.There was a high negative correlation between the temperature difference between the two groups(R=-0.8488,p<0.05).3.With the increase of perfusion times,the tolerable perfusion flow rate decreased.There was a significant difference between the first perfusion flow rate and the last perfusion flow rate(p<0.05).4.Compared with the short-term efficacy of two groups of patients,the total effective rate of high flow rate group was 100%;the total effective rate of low flow group was 93.33%.There was no significant difference in the short-term efficacy between the two groups(χ~2=3.33,p>0.05);there was no significant difference in the adverse reactions of digestive system,liver,kidney and bone marrow hematopoietic system between the two groups(p>0.05).5.The average loss rate of cisplatin was 31.63%±7.91%of the total chemotherapy drug concentration before HIPEC started.The loss rate of cisplatin in low flow rate group was 28.32%±11.91%,and that in high flow rate group was35.64%±8.32%.ConclusionHigh flow rate can keep the temperature of intraperitoneal perfusion fluid constant.When the perfusion difference is within 2℃,a lower flow rate can reduce the loss rate of cisplatin in the perfusate in vitro.By adjusting the flow rate of HIPEC,the perfusion temperature and drug utilization rate can be changed,which has a guiding significance for the formulation of clinical treatment regimen of HIPEC.