Lung protection induced by goal-directed fluid therapy in patients undergoing pulmonary lobectomy / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the lung protection induced by goal-directed fluid therapy (GDFT) in the patients undergoing pulmonary lobectomy.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 35-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective pulmonary lobectomy with general anesthesia, were divided into 2 groups ( n=40 each) using a random number table method: control group (group C) and GDFT group (group G). In group C, mean arterial pressure was maintained at 65-90 mmHg, central venous pressure at 8-12 cmH 2O, and urine volume>0.5 ml·kg -1·h -1.In group G, GDFT was performed, maintaining cardiac index>2.5 L·min -1·m -2 and stroke volume variation ≤11%.Peak airway pressure and plateau airway pressure were recorded immediately after intubation (T 1), 30 min of one-lung ventilation (T 2), 1 h of one-lung ventilation (T 3) and at the end of the surgery (T 4). Blood samples were collected from the radial artery at T 1-4 and 24 h after operation (T 5) for blood gas analysis to determine the alveolar-arterial difference of oxygen tension (A-aDO 2). Broncho-alveolar lavage fluid (BALF) and blood samples from the internal jugular vein were collected at T 1 and T 4 to detect the concentrations of interleukin-6 (IL-6) and IL-10 in serum and BALF, and the ratio of IL-6 to IL-10 was calculated.Ultrasound was used to measure the inferior vena cava respiratory variations index at T 1, 4.The intraoperative total volume of fluid infused, amount of colloid solution infused, urine volume and blood loss were recorded, and the hospitalization time was also recorded. Results:Compared with group C, peak airway pressure and plateau airway pressure at T 2-4, A-aDO 2 at T 2-5, concentration of IL-6 in BALF at T 4 and IL-6/IL-10 ratio were significantly decreased, the total volume of fluid infused and urine volume were reduced, and the amount of colloid solution infused was increased in group G ( P<0.05). Conclusion:GDFT can improve the intraoperative respiratory dynamics, inhibit inflammatory responses in lung tissues and improve lung function in the patients undergoing pulmonary lobectomy.