在卵巢癌手术中的手术内流体平衡和术后并发症
Eva K Egger1, Janina Ullmann2, Tobias Hilbert3
1Department of Gynecology and Gynecological Oncology, University Hospital, Bonn, Germany. eva-katharina.egger@ukbonn.de.
Annals of surgical oncology
|October 8, 2024
概括
在卵巢癌手术中实施脉压变化引导流体管理 (PPVGFM) 显著减少了严重的术后并发症. 这种流体管理策略是安全的,并通过最大限度地减少流体过载来改善患者的结果.
科学领域:
- 麻醉学 麻醉学
- 手术瘤学手术瘤学
- 临界护理医学 临界护理医学
背景情况:
- 流体过载和低血压是卵巢癌细胞减少手术中术后并发症的重要危险因素.
- 优化流体管理对于改善患者在这种复杂的手术环境中的结果至关重要.
研究的目的:
- 调查实施脉压变化引导流体管理 (PPVGFM) 对术后并发症和静脉漏的影响.
- 在接受卵巢癌手术的患者中,比较PPVGFM引入前后的结果.
主要方法:
- 对243名接受卵巢癌细胞削减手术的患者进行了回顾性评估.
- 两个队列的比较:在PPVGFM实施之前接受治疗的A队列 (n=185) 和PPVGFM实施后接受治疗的B队列 (n=58).
- 术后并发症的分析,包括超严重和严重的并发症,以及静脉漏.
主要成果:
- 与PPVGFM前组 (A组) 相比,PPVGFM组 (B组) 的超严重并发症 (G4/G5) 显著减少.
- 在B队列中观察到较低的中位数阳性液体过剩,独立于瘤负担和FIGO阶段.
- 在B组中,第一次术后排便的时间缩短,住院时间缩短,以及对重症监护和术后通风的需求减少.
- 阳性液体过量 (PFE) ≥3000毫升与更严重的并发症有关,PFE ≥4000毫升与增加的道泄漏有关.
结论:
- 以PPVGFM为指导的手术内流体管理在减少卵巢癌手术中超严重的术后并发症方面是安全有效的.
- 特定的阳性液体过剩值 (≥3000毫升和≥4000毫升) 被确定为严重并发症风险增加的指标.
- PPVGFM代表了优化流体平衡和改善卵巢癌患者手术结果的有价值策略.
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