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Objective To explore the effects of positive end-expiratory pressure on intraoperative pulmonary function and respiratory mechanics in patients receiving continuous hyperthermic peritoneal perfusion.Methods Ninety patients (55 males,35 females,aged 40-70 years,ASA grade Ⅰ-Ⅲ) undergoing continuous hyperthermic peritoneal perfusion were selected and divided into 3 groups (n=30 each): regular volume controlled ventilation group (group A),5 cm H2O PEEP group (group B) and 10 cm H2O PEEP group (group C).After tracheal intubation,the mechanical ventilation parameters in groups A,B and C were respectively given tidal volume (VT) 10 ml/kg without positive end-expiratory pressure (PEEP),VT 6 ml/kg with 5 cm H2O PEEP,and VT 6 ml/kg with 10cm H2O.PETCO2 was maintained at 35-45 mm Hg.Arterial blood samples were collected for blood gas analysis 5 min after (T1),before CHPP (T2),the end of CHPP (T3),and before the end of mechanical ventilation (T4).Besides,Pplat,Pmean,Ppeak,PaCO2,PaO2were recorded and Cdyn,OI,RI,A-aDO2 as well as VD/VT were calculated at all time points simultaneously.Pulmonary complications during 7 days after surgery were also recorded.Results Compared with group A,Ppeak,Pplat,A-aDO2 and RI were all significantly lower (P<0.05),while OI and VD/VT were higher in groups B and C at T1-T4 (P<0.05);at T2-T4,Cdyn and PaO2 were higher with lower Pmean in groups B and C (P<0.05).Compared with T1,Ppeak,Pplat and Pmean were higher (P<0.05) while Cdyn was lower (P<0.05) in group A at T2-T4;In Group B,Ppeak and Pplat were higher at T3 (P<0.05),Pmean was higher at T2-T4 (P<0.05) and Cdyn was lower at T3,T4 (P<0.05);in group C,Ppeak,Pplat and Pmean were all higher at T2-T4 (P<0.05),Cdyn was lower at T3,T4 (P<0.05);OI and PaO2 were lower (P<0.05),while A-aDO2,VD/VT and RI were all higher (P<0.05) at T2-T4 in the three groups.In addition,the incidence rates of pulmonary infection,hypoxemia,and atelectasis were significantly lower in groups B and C during 7 days after surgery than those of group A (P<0.05).Conclusion PEEP (5 cm H2O) with VT (6 ml/kg) could effectively improve intraoperative pulmonary function and reduce the risk of perioperative pulmonary complications of the patients receiving continuous hyperthermic peritoneal perfusion.
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Objective To discuss the effects of the goal-directed fluid therapy on the haemody-namics,oxygen delivery and consumption and tissue perfusion in patients with continuous hyperther-mic peritoneal perfusion.Methods Eighty patients (61 males,19 females,aging from 30 to 60years old,ASA grade Ⅰ-Ⅲ)undergoing continuous hyperthermic peritoneal perfusion were selected and di-vided into 2 groups (n=40).Conventional liquid treatment group(group C)and Stroke Volume Vari-ation-directed liquid treatment group(group S).All patients were received general anesthesia and mo-nitored with FloTrac/Vigile systerm.MAP,HR,CVP,CI,PaO2 ,SaO2 ,PvO2 ,ScvO2 and Lac were all recorded in the time before anesthesia(T0 ),5 min after endotracheal intubation (T1 ),before CHPP (T2 ),CHPP for 30 min (T3 ),CHPP for 60 min (on the end,T4 ),30 min after CHPP (T5 ), and at the end of surgery (T6 ).According to the formula to calculate oxygen transport (DO2 I)and oxygen consumption index (VO2 I).Results Compared with group C,the amount of fluid, crystalloid solution,and urine volume were all much lower and colloidal solution was much higher in group S (P <0.05).Compared with T1 ,MAP decreased in the two groups at T3 and T4 ,yet HR in-creased and CVP decreased in group C at T4 (P <0.05).CVP increased in group C at T6 and in group S at T3-T5 .At the time points of T3 to T6 ,MAP and CI in group S were significantly higher than those in group C,while CVP and HR were much lower in group S (P <0.05).Compared with T1 , the DO2 I in group C were lower at T4 ,T5 (P <0.05),while VO2 I,O2 ER and Lac in group C in-creased at T3-T6 (P <0.05),also ScvO2 decreased at the same time (P <0.05).Compared with T1 , the VO2 I increased at T4-T6 ,but ScvO2 decreased at T3 ,T4 in group S (P <0.05).DO2 I in group S were higher than those in group C at T4 and T5 ,whereas,VO2 I,O2 ER and Lac level in group S were much lower than those in group C,and ScvO2 were significantly higher than those at T3-T6 in group C (P <0.05).Conclusion Stroke variation degree-oriented liquid treatment could effectively maintain hemodynamic stability,increase the body's oxygen supply,reduce oxygen consumption and improve tissue perfusion.
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Objective To study the nursing methods of gastrointestinal cancer patients undergoing continuous hyperthermic peritoneal peffusion chemotherapy (CHPPC) in the peri-operative period.Methods A total of 126 patients with gastrointestinal cancer underwent continuous hyperthermic peritoneal perfusion chemotherapy,and nursing care was implemented continuously,comprehensively and individually.Results All of the patients underwent continuous hyperthermic peritoneal perfusion chemotherapy successfully,without any complication occurred.Conclusions Intensive and effective nursing care is helpful to carry out continuous hyperthermic peritoneal perfusion chemotherapy safely,and avoid the complications.
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BACKGROUND: Continuous hyperthermic peritoneal perfusion (CHPP) has been introduced to improve the survival of the advanced cancer patients. It is a technique that allows uniform delivery of cytotoxic agents and heat to the peritoneal surface. However CHPP - induced acute changes of body temperature and intraabdominal pressure could produce various abnormal physiologic responses, especially hypoperfusion and hypoxia. These factors may further contribute to the renal dysfunction. Moreover, transperitoneal absorption of drugs resulting in systemic toxicity and certain anticancer drugs have an inherent nephrotoxicity. The aim of the present study was to investigate the effect of anticancer drugs on the kidney in the ovarian cancer patients after CHPP. METHODS: CHPP with anticancer agents in warm saline was performed in 54 patients with cancer of the ovary at temperature 47 degrees C for 90 minutes under general anesthesia. Forty nine patients were given carboplatin and 5 patients were received cisplatin intraperitoneally at an equi-toxic dose. To clarify the effect of cisplatin and carboplatin on the kidney, serum creatinine and blood urea nitrogen (BUN) were measured before anesthesia, 1, 3 and 7th day after surgery in both agents. RESULTS: There were no significant changes of creatinine level on 1, 3 and 7 days postoperatively compared to preoperative creatinine in carboplatin patients. In carboplatin patients, postoperative BUN levels were decreased significantly on 1 and 3 days, but they were within normal range. BUN level of postoperative 7 day showed no significant change. In cisplatin patient, there was insignificant increase of BUN and creatinine levels on 1, 3 and 7 days postoperatively. CONCLUSIONS: These results suggest that carboplatin did not suppress renal function until 7 days after CHPP. Cisplatin markedly increased the creatinine and BUN until 7 days postoperatively, but there was no statistical significance.
Subject(s)
Humans , Absorption , Anesthesia , Anesthesia, General , Hypoxia , Antineoplastic Agents , Blood Urea Nitrogen , Body Temperature , Carboplatin , Cisplatin , Creatinine , Cytotoxins , Hot Temperature , Kidney , Ovarian Neoplasms , Perfusion , Reference ValuesABSTRACT
Purpose: To study the treatment of metastasis of late digestive tract cancer?Methods:58 patients with late digestive tract cancer were divided into two groups. One group (reference group) of patients 28 cases were underwent chemotherapeutic treatment while another (treatment group) 30 cases were treated with DDP by CHPP. Results:Through DDP by CHPP (treatment group) the treatment show effectiveness as much 63.3% higher than that of reference group as 39.3%. This indicates the fact that there were significant differences between the groups ( P 0.05)Conclusions: DDP with Cisplatin by CHPP on patients with late digestive tract cancer, especially those patients followed by ascites, can evidently enhance the effectiveness of the treatment.
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BACKGROUND: Continuous hyperthermic peritoneal perfusion (CHPP) has been introduced to improve the survival of cancer patients. However CHPP induced acute change of body temperature and intra- abdominal pressure could produce various abnormal physiologic responses, especially acid-base and electrolyte imbalance. The purpose of this study was to evaluate the effects of intravenous fluids, plasma solution and Hartmann's solution on acid-base status and electrolyte concentrations during CHPP and to determine strategies for safer fluid management. METHODS: Thirty five patients with ovarian cancer were divided into two groups; Group 1 (16 patients) was supplied with plasma solution and Group 2 (19 patients) was supplied with a Hartman solution as the intravenous fluid. Closed peritoneal irrigation was done with perfusate at a temperature of 47oC for 90 min under general anesthesia. Body temperature, hemodynamic parameters (mean arterial pressure MAP, heart rate HR), blood gas tensions (PaO2, PaCO2), acid-base parameters (pH, base deficit BD) and electrolytes (sodium, potassium, calcium) were measured at 10 min before CHPP, 30, 60, 90 min after the initiation of CHPP, and 30 min after the end of CHPP. RESULTS: There were no significant changes in body temperature, MAP, HR, PaO2, PaCO2 during CHPP in both groups. pH measured at postCHPP in group 2 was significantly lower than that measured in group 1. Base deficits measured at 30, 60, 90 min after the initiation of CHPP and 30 min after the end of CHPP in group 2 were significantly lower than those measured in group 1. Potassium and calcium ion concentations did not show statistical significance during CHPP in both groups. 7 patients in group 1 whose calcium ion level dropped by more than 20% of the initial value needed a calcium injection but only 1 patient in group 2 needed a calcium injection. CONCLUSION: It appears that hemodynamic stability was maintained well during CHPP between the two group. A plasma solution may be more ideal in reducing acidic tendencies and base deficits thana Hartmann's solution but a plasma solution supplied group requires frequent evaluation and a supply of calcium for adequate serum calcium levels.
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Humans , Acid-Base Equilibrium , Anesthesia, General , Arterial Pressure , Body Temperature , Calcium , Electrolytes , Heart Rate , Hemodynamics , Hydrogen-Ion Concentration , Ovarian Neoplasms , Perfusion , Peritoneal Lavage , Plasma , PotassiumABSTRACT
BACKGROUND: Intra-operative application of continuous hyperthermic peritoneal perfusion (CHPP) in advanced cancer has been introduced as an effective and safe method to lessen the complication and enhance the effectiveness of its treatment. But CHPP induced acute change of body temperature and intra-abdominal pressure would produce various abnormal physiologic response. Now, we investigated to evaluate and understand the trend of changes of cardiac and oxygen parameters during CHPP. METHODS: Closed peritoneal irrigation was done with perfusate at temperature 47oC for 90 min under general anesthesia. Cardiac and oxygen parameters were measured at 10 min before CHPP, 30, 60, 90 min after the initiation of CHPP, 30 min after the end of CHPP with Swan-Ganz catheter application. RESULTS: Hemodynamic parameters; Systemic vascular resistance index and mean arterial pressure were decreased trend during CHPP. Pulmonary capillary wedge pressure and cardiac index were increased during CHPP. Oxygen parameters; AaDO2 and shunt fraction were increased during CHPP and O2 index were decreased during CHPP. Oxygen balance; O2 consumption and delivery increased during CHPP. CONCLUSIONS: We confirmed that systemic oxygen consumption and delivery were increased during CHPP but AaDO2 and shunt fraction were increased which could decrease systemic oxygen delivery. We should need more careful monitoring and proper treatment for maintaining stable hemodynamics and systemic oxygen balance during and after CHPP.
Subject(s)
Anesthesia, General , Arterial Pressure , Body Temperature , Catheters , Hemodynamics , Oxygen Consumption , Oxygen , Perfusion , Peritoneal Lavage , Pulmonary Wedge Pressure , Vascular ResistanceABSTRACT
Continuous hyperthermic peritoneal perfusion(CHPP) has been used for patients with advanced gastric cancer and peritoneal seeding. Changes in hemodynamic, arterial blood gas, acid-base balance, electrolytes and body temperature were evaluated in 10 patients with advanced gastric cancer during CHPP. 1) Cardiac index, heart rate and mean arterial pressure were significantly increased. Systemic vascular resistance index was significantly increased at 10 min. after start of CHPP and signihcantly decreased after 30 min. Central venous pressure was very increased during CHPP. 2) Arterial oxygen tension was gradually decreased and arterial carbon dioxide tension was not changed. Significant metabolic acidosis was developed during CHPP. 3) Sodium was significantly increased and ionized calcium was significantly decreased. Potassium was not changed. 4) Temperature of midesophagus was increased mean 3.8 degrees C at 50 min. after start of CHPP. In conclusions there were significant changes in hemodynamics, arterial blood gas, acid-base balance, electrolytes and body temperature during CHPP. We should need complete preparation, careful monitoring and attention during and after CHPP.
Subject(s)
Humans , Acid-Base Equilibrium , Acidosis , Arterial Pressure , Body Temperature , Calcium , Carbon Dioxide , Central Venous Pressure , Electrolytes , Heart Rate , Hemodynamics , Oxygen , Perfusion , Potassium , Sodium , Stomach Neoplasms , Vascular ResistanceABSTRACT
To study the treatment of peritoneal and hepatic recurrence of advanced gastric carcinoma after operation, 218 patients were divided into treatment group and control group.Treatment group: (hyperthemic peritoneal perfusion and intraarterial infusion chemotherapy)126 cases. Control group (peripleral veins): 92 cases. The peritoneal and hepatic recurrence and 3 year survival rate of each group were analyzed. The peritoneal and hepatic recurrence and 3 year survival rate in treatment group were 27%, 12 7% and 69 5%. and were 44 5%, 26 1% and 47 8% in control group. Hyperthermic peritoneal perfusion and intraarterial infusion chemotherapy are effective in control of the recurrence of advanced gastric cancer after operatin.