| Objectives To observe the effect of goald directed fluid therapy and Conventional liquid therapy on intestinal mucosal function and motor function of intestine in patients undergoing laparoscopic pancreaticoduodenectomy.To investigate the gastrointestinal function recovery,tolerance of enteral nutrition in these patients who taked goal-directed fluid therapy for pancreatoduodenectomy.Methods A total of 60 patients undergoing pancreatoduodenectomy under general anesthesia were choosed.The 60 patients aged 35-65 years old,male 31 cases and female 29 cases,ASA class ???.These patients were included from June 2017 to June 2019 in Kailuan General Hospital.But one of the patients has inoperable due to extensive tumor infiltration,five of the patients were converted to open laparoscopy during surgery and one of the patients had a severe allergic reaction to intraoperative hydroxyethyl starch.These 7 patients dropped out of the study and 53 patients were eventually Incorporated.The 53 patients were randomly divided into two groups,G(n=27)and C(n=26).Goal-directed fluid therapy was used in Group G,whereas conventional fluid therapy was used in group C.Liquid management,dosages of vasoactive drugs,operation time,urine volume,blood loss,number of cases of concentrated red blood cell input,tracheal extubation time and hospital stay were recorded.Mean arterial pressure(MAP),heart rate(HR),cardiac index(CI),central venous pressure(CVP),stroke volume variation(SVV),lactic acid(Lac)and Central venous oxygen saturation(ScvO2)of patients were recorded before anesthesia(T0),the time when the surgery begin(T1),the time when the specimen be removed(T2),and the time when the operation be over(T3)Choose seven time points,such as T0-T3 and 1,2 and 3 days(T4,T5,T6)after operation.Central venous blood was drawn and detected by using enzyme-linked immunosorbent determination in the plasma diamine Oxidase,(DAO),D-Lactic and lipopolysaccharide(LPS)were detected.Neurotrophin-3(NT-3)and galanin(GAL)were detected at the time T0-T3.Results Two groups of patients with surgery,gender,age,ASA physical status,BMI,Operating hours and hospital stays general data difference has no statistical significance(P>0.05),two groups of patients were generally comparable.Compared with group C at T2 to T3,the MAP increased,CVP decreased,SVV decreased,CI increased,low Lac,high ScvO2(P>0.05).The amount of crystalloid requirements and total infusion in group G were less than that of group C(P>0.05),colloidal solution and dopamine usage in group G were fewer than that of group C(P<0.05).The extubation time of tracheal intubation in group G was earlier than that in group C(P<0.05).The plasma DAO,D-lactic acid and LPS in group G were lower than those in group C at the time T2-T6.The peak of DAO,D-lactic acid and LPS appeared on the first day after operation,and then began to decrease.Comparing with T0,NT-3 went up at T1?T2 and decreases at T3.The change of G group was more obvious than that of C group.However,plasma GAL increased continuously at T2 and T3.Similarly,the changes in group G were more obvious than those in group C.G group of patients the incidence of postoperative hypotension,nausea and vomiting were ower than that in group C,the difference was statistically significant(P<0.05),and postoperative spectrum error,arrhythmia,wound infection,pulmonary complications,postoperative bleeding,gastric emptying dysfunction,the incidnce of complications such as fever and pancreatic leakge in group G were lower than that of group C,but there was no statistically sigificant difference(P>0.05).Conclusions 1 Goal-directed fluid therapy used in patients undergoing laparoscopic pancreaticoduodenectomy can better maintain the stability of hemodynamics in the operation and maintain the stability of tissue perfusion.Improves microcirculation and tissue oxygenation.2 Goal-directed fluid therapy for patients undergoing laparoscopic pancreaticoduodenectomy can reduce the damage of intestinal barrier function and has a protective effect.3 Goal-directed fluid therapy to avoid the inappropriate infusion on gastrointestinal perfusion inadequacy or edema,promote the intestinal movements.It is beneficial to the recovery of intestinal motility function.Figure 14;Table 8;Reference 134... |
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