| BackgroundCervical cancer is one of the most common gynecological malignancies.The number of new cases of cervical cancer is as high as 130000 every year in China.It becomes the second largest gynecological malignancy after breast cancer,which has a serious impact on women's life and health.The surgical treatment is the most important treatment for cervical cancer at present,but the incidence of postoperative nausea and vomiting(PONV)is as high as 70%-80%because of non-smoking patients in female,long-term abdominal surgery,opioid use and other factors.On the other hand,it can lead to obvious discomfort and decreased satisfaction of patients,increase medical expenses and prolong hospital stay.Some of them are serious,even lead to electrolyte disorder,wound tear,incisional hernia formation,aspiration pneumonia,asphyxia death and so on.With the deepening of the research on PONV mechanism,for high-risk patients,in addition to the combination of antiemetic drugs with different mechanisms and rational use of narcotic drugs,many scholars have found that the optimal volume therapy can improve the occurrence of PONV.Among them,through the stroke volume variation(SVV),it can well predict the response of patients' circulatory system to fluid,with high sensitivity and specificity.The goal directed fluid therapy(GDFT)guided by SVV can significantly improve tissue perfusion,It can maintain the hemodynamic stability and reduce the incidence of PONV.However,SVV needs invasive puncture and expensive consumables,which limits its use.As a new method based on the variation of pulse perfusion pressure with respiratory cycle,the pulse perfusion index(PVI)can be used to assess the body capacity state noninvasively and continuously.At the same time,a large number of studies have also proved that in patients with mechanical ventilation,the accuracy of PVI in assessing capacity status is similar to SVV.In order to explore the preventive effect of PVI on PONV in high-risk patients and provide more reliable basis for clinical application,we designed this clinical study.ObjectTo investigate the effects of volumetric therapy guided by PVI on postoperative nausea and vomiting(PONV)in patients undergoing laparoscopic radical resection of cervical carcinoma.MethodsWe selected 60 patients undergoing elective in downlink laparoscopic general anesthesia in patients with cervical cancer radical,ASA class ?-?,aged 40 to 65 years of age,body mass index(BMI)of 18 to 25 kg/m2.The subjects were randomly divided into two groups:the traditional rehydration group(group C)and the volume therapy guided by PVI(group PVI).In the rehydration plan,the amount of rehydration in group C was made up of hysiological requirement,continuous loss,cumulative loss,compensatory expansion and third gap loss.Physiological demand and cumulative deficiency were supplemented with ringer's solution of sodium lactate in accordance with the rule of 4.2.1.The continuous loss was supplemented with.hydroxyethyl starch 130/0.4 sodium chloride injection according to the blood loss and urine output.Compensatory volume expansion was supplemented with ringer's solution of sodium lactate before anesthesia induction,with a volume of 5ml/kg.The third gap loss was supplemented by ringer's solution of sodium lactate with 2ml/kg/h.The compensatory volume expansion of PVI group was supplemented before anesthesia induction in the same way as group C.After anesthesia induction,intravenous infusion of Ringer's solution of sodium lactate was 4ml/kg/h.According to the guidance of PVI,hydroxyethyl starch 130/0.4 sodium chloride injection was given for rapid fluid replacement when PVI was more than 14%.Colloidal fluid replacement was stopped until PVI was less than 14%.General data of patients,such as age,body mass index,ASA grade,preoperative Hb level,operation time,intraoperative temperature,intraoperative opioid dosage,were recorded.Intraoperative volume,such as total volume of fluid input,crystal volume,colloid volume,urine volume and bleeding volum,were recorded.The intraoperative hemodynamic parameters(HR,MBP,SBP,DBP)and PVI were recorded at the time of before induction of anesthesia(T1),before operation(T2),after operation 2 hours(T3),after operation 4 hours(T4)and at the end of operation(T5).Record T1,T3,T5 blood gas indexes(pH,LAC,BE)and the value of venous oxygen saturation(SVO2).The serum 5-HT was recorded at different time points.The time of first exhaust,defecation and inflow of fluid were recorded.The incidence of nausea and vomiting was recorded at 6h,12h and 24h postoperatively,and the severity of PONV was evaluated by WHO classification.Results(1)There was no significant difference in age,body mass index,ASA classification,Hb level before operation,operation time,body temperature,opioid dosage,bleeding volume and hemodynamic indexes between the two groups(P>0.05).(2)The amount of intraoperative fluid and crystal fluid,urine output in PVI group was significantly less than that in C group,but the amount of colloid fluid was significantly more than that in C group(P<0.05).(3)In PVI group,Lac value was significantly lower than that in C group,and BE,SVO2 value was significantly higher than that in C group(P<0.05).(4)The time of first exhaust,defecation and inflow of fluid in PVI group was significantly shorter than that in C group(P<0.05).(5)The serum 5-HT level in PVI group was significantly lower than that in C group(P<0.05).(6)The incidence and severity of PONV in PVI group were significantly lower than that in group C(P<0.05).ConclusionCompared with traditional volume therapy,the volume therapy guided by PVI,can significantly reduce the incidence and severity of PONV in laparoscopic radical surgery for cervical cancer,by optimized tissue perfusion and exhibited lower levels of 5-HT in blood. |
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