Abstract
Objective: To explore the effects of goal-directed fluid therapy (GDFT) on lung function, cognitive function and inflammatory response in patients undergoing radical esophageal cancer surgery under one-lung ventilation. Methods: Sixty-seven patients undergoing radical esophageal cancer surgery were divided into GDFT group (GDFT therapy) and control group (conventional liquid therapy). The changes in patients’ pulmonary function, cognitive function and inflammatory response were evaluated. Results: Both alveolar-arterial oxygen partial pressure difference [P(A-a)O2] and respiratory index (RI) increased at one-lung ventilation for 30 minutes (T2) and decreased at one-lung ventilation for 60 minutes (T3), and after surgery (T4) in the two groups, and the GDFT group was lower than the control group (P 0.05); theoxygenation index (OI) of the two groups decreased at T2, T3, and T4 compared with that at T1 (before one-lung ventilation), and the GDFT group was higher than the control group (P 0.05). At T4 and T5, the tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), central nervous system specific protein (S100β), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P 0.05), while interleukin-10 (IL-10) was higher compared to the control group (P 0.05); the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P 0.05). Conclusion: GDFT can help prevent lung injury during radical esophageal cancer surgery under one-lung ventilation, reduce the body’s inflammatory response, and reduce the incidence of perioperative cognitive disorder to a certain extent.
Highlights
One-lung ventilation (OLV) is non-physiological ventilation, which is usually used in thoracic surgery for a favorable surgical field
The changes in patients’ pulmonary function, cognitive function and inflammatory response were evaluated. Both alveolar-arterial oxygen partial pressure difference [P(A-a)O2] and respiratory index (RI) increased at one-lung ventilation for 30 minutes (T2) and decreased at one-lung ventilation for 60 minutes (T3), and after surgery (T4) in the two groups, and the goal-directed fluid therapy (GDFT) group was lower than the control group (P < 0.05); theoxygenation index (OI) of the two groups decreased at T2, T3, and T4 compared with that at T1, and the GDFT group was higher than the control group (P < 0.05)
At T4 and T5, the tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), central nervous system specific protein (S100β), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P < 0.05), while interleukin-10 (IL-10) was higher compared to the control group (P < 0.05); the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P < 0.05)
Summary
One-lung ventilation (OLV) is non-physiological ventilation, which is usually used in thoracic surgery for a favorable surgical field This ventilation may cause lung ischemia/reperfusion injury, increased intrapulmonary shunt, inflammatory response, and further induce acute lung injury, thereby leading to poor prognosis of the patients [1]. Most of the patients receiving radical surgery for esophageal cancer are elderly, who have reduced organ reserve and are less tolerant to perioperative hemodynamic fluctuation and cerebral oxygen metabolism disorder. According to a clinical survey [4], poor perioperative fluid management is one risk factor for lung injury and postoperative complication after radical surgery for esophageal cancer. We investigated the influence of GDFT on lung function, cognitive function, and inflammatory response in patients who received radical surgery for esophageal cancer under OLV
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