A Study Based On GDFT Combined With Methoxamine In Intraoperative Volume Management Of Ovarian Cancer Patients Undergoing Neoadjuvant Chemotherapy In A Single Center

Objective:The onset of ovarian cancer is insidious,and more patients are in advanced stage.The number of patients who underwent neoadjuvant chemotherapy before surgery is also increasing.The function of heart,blood vessels,nerve,liver and kidney are damaged to varying degrees by neoadjuvant chemotherapy.Intraoperative volume insufficiency or volume overload can aggravate organ damage and cause serious consequences.There have been no studies of fluid therapy regimens for ovarian cancer patients treated with neoadjuvant chemotherapy.Our previous study showed that GDFT combined with methoxamine achieved good results in ovarian tumor cytoreductive surgery.We modified the fluid infusion scheme on the basis of the original,explored the effect of the new scheme in intraoperative fluid therapy of patients with neoadjuvant chemotherapy,and summarized the characteristics of intraoperative circulation of patients with neoadjuvant chemotherapy.Methods:From December 2021 to December 2022,20 patients with ovarian cancer who underwent surgery without neoadjuvant chemotherapy in the Third Affiliated Hospital of Kunming Medical University were selected as control group A.Forty patients with ovarian tumor cytoreductive surgery undergoing neoadjuvant chemotherapy were selected as experimental group B.In both groups,stroke volume variation（SVV）<13%,cardiac index（CI）2.5-4.0 L/（min.m²）,mean arterial pressure（MAP）fluctuation less than 20%of base,SVRI between1700-2600(Dynes-sec/cm^-5/m²)were the targets.The rehydration method was as follows:when MAP decreased and SVV>13%,a dynamic evaluation test was performed.The test included:first,SVRI was measured,SVRI was less than1700(Dynes-sec/cm^-5/m²),vasoactive drugs were used,then fluid impulse test was performed,and the fluid impulse therapy was evaluated again,ΔSV increased>10%,and the basal infusion rate was accelerated until SVV<13%.The general data such as age,body mass index（BMI）and ASA classification of the two groups were recorded.The duration of anesthesia,operation time,and extubation time were recorded.Take the following times as nodes:The heart rate（HR）,mean arterial pressure（MAP）,stroke volume（SV）,cardiac output（CO）and stroke volume variation（SVV）were recorded before anesthesia induction（T0）,before tracheal intubation（T1）,beginning skin incision（T2）,1 hour after operation（T3）,2 hours after operation（T4）and the end of operation（T5）).The peripheral vascular resistance index（SVRI）was recorded at T0,T1,T2,T3,T4,T5 in the two groups.Arterial blood samples were collected at T0,T3,T4 and T5 for blood gas analysis,and PH and lactic acid values were recorded.Fluid use during surgery was recorded,including crystalloid volume,colloid volume,and total infusion volume.The volume of urine and blood loss during operation were recorded.The use of phenylephrine and ephedrine in the two groups during the operation was summarized.The renal function,including blood urea nitrogen（BUN）and creatinine（Cr）,were recorded before operation,1 day and 3 days after operation.Liver function:albumin（Alb）,aspartate aminotransferase（AST）,alanine aminotransferase（ALT）;Cardiac function was assessed by Nt-pro BNP.The complications within three days after operation were recorded:hypotension,nausea and vomiting（PONV）,pulmonary infection,pulmonary edema,dyspnea,sinus tachycardia,sinus bradycardia,cardiac insufficiency,liver insufficiency,and renal insufficiency.The first exhaust time,the first defecation time and the postoperative hospital stay were recorded.Result:There was no significant difference in age,weight,height and BMI between the two groups（P>0.05）.There was no significant difference in extubation time（min）between the two groups（P>0.05）.main result:Compared with group A,the preoperative ALT,AST and Cr in group B were increased,and the difference was statistically significant（P<0.05）.The levels of ALT,AST,Cr and Nt-pro BNP in group B on the first day after operation were higher than those before operation,and the differences were statistically significant（P<0.05）.The ALT,AST,Cr and Nt-pro BNP of the two groups on the third day after surgery were lower than those on the first day,and the differences were statistically significant（P<0.05）.The Alb of the two groups was significantly lower 1 day after surgery than that before surgery（P<0.05）.The Alb of the two groups on the third day after operation was higher than that before operation,and the difference was statistically significant（P<0.05）.There was no significant difference in BUN between the two groups before operation,1 day and 3 days after operation（P>0.05）.Compared with group A,the first postoperative exhaust time,first feeding time and postoperative hospital stay were shortened in group B（P<0.05）.There was no hypotension,pulmonary infection,pulmonary edema,dyspnea,cardiac insufficiency,liver insufficiency,and renal insufficiency in the two groups.Among them,1 patient in group A had vomiting,1 patient in group B had nausea,and 1 patient had nausea and vomiting,there was no significant difference between the two groups（P>0.05）.There was no significant difference in other postoperative complications between the two groups（P>0.05）,and there was no death in the two groups.Secondary Result:Compared with T0,the HR of the two groups at T1-T5 gradually slowed down（P<0.05）.There was no significant difference in HR between the two groups at different time points（P>0.05）.Compared with T0,MAP,CO and SV in both groups decreased at T1,but the decrease did not exceed 20%at T0（P<0.05）.At T3-T5,compared with group A,the MAP,CO and SV of group B decreased significantly（P<0.05）;At T4 and T5,CO and SV in the two groups were higher than those at T1（P<0.05）.The increase of CO and SV in group A at T4 and T5 was more than 20%of that at T0（P<0.05）.There was no significant difference in SVV between group A and group B at T2-T5（P>0.05）.The SVRI of group B was lower than that of group A at T2-5（P<0.05）.But group A SVRI>2000（Dynes-sec/cm-5/m2）;Compared with group A,the intraoperative consumption of ephedrine and phenylephrine was significantly increased in group B（P<0.05）.The Lac of the two groups at T5 was higher than that at T0,and the Lac of group B increased more significantly（P<0.05）.Compared with group A,the amount of bleeding in group B was significantly reduced（P<0.05）.Compared with group A,the colloid volume and total infusion volume were significantly increased in group B（P<0.05）.There was no significant difference in urine volume between the two groups（P>0.05）.Compared with group A,the transfusion of blood products in group B was reduced（P<0.05）.Compared with group A,the operation time of group B was shortened,and the difference was statistically significant（P<0.05）.Conclusions:1.Chemotherapy drugs also resulted in the increase of preoperative liver and kidney indicators,low intraoperative circulation indicators,increased use of vasoactive drugs,and increased total infusion volume.More attention should be paid to anesthesia management.2.With the target-directed fluid therapy combined with methoxamine,the intraoperative hemodynamics of the patient was stable,and there was no liver and kidney function injury or cardiac function injury caused by the addition of chemotherapy drugs after surgery.