Malign asitli over kanserinde sitoredüktif cerrahide perioperatif hemodinamik optimizasyon

Year 2022, , 950 - 960, 30.09.2022

Güneş Özlem Yıldız , Gokhan Sertcakacilar , Duygu Akyol , Sema Karakaş , Gülsüm Oya Hergünsel

https://doi.org/10.17826/cumj.1097476

Abstract

Amaç: Bu çalışmada malign asitli epitelyal over kanserli hastalarda plazma onkotik basıncı ve intravasküler volümü korumak, perioperatif hemodinamik stabilizasyon ve doku perfüzyonunu sağlamak amacıyla norepinefrin ve albümin kullanımının etkilerini değerlendirmeyi amaçladık. Ayrıca postoperatif yoğun bakıma yatış, hastanede kalış ve komplikasyonlar açısından da karşılaştırılması amaçlandı.
Gereç ve Yöntem: Bu çalışmaya over kanseri nedeniyle sitoredüktif cerrahi uygulanan 38 asitli ve 28 asitsiz toplam 66 hasta dahil edildi. Hastaların hemodinamik stabilizasyon sonrası (ameliyat başladıktan sonra) (T0) PVI ve invaziv arter monitorizasyonu yapıldı. T0, 1. saat (T1) ve 2. saat (T2) ve postoperatif (Tpostop.) hastaların kan gazı ve hemodinamik verileri kaydedildi. Asit hastaları, norepinefrin (NE) infüzyonu, norepinefrin + albümin (NEA) infüzyonu veya sadece sıvı tedavisi (FT) uygulanan 3 alt gruba ayrıldı. Hastaların perioperatif hemodinamik ve laboratuvar verilerinden doku perfüzyonu laktat ile, hemodinamik durumu plet değişkenlik indeksi (PVI), perfüzyon indeksi (PI) ve ortalama arter basıncı (MAP) ile değerlendirildi.
Bulgular: Demografik ve klinik bulgular asitli ve asitsiz hastalar arasında anlamlı farklılık göstermedi. Tpostop'ta NEA/NE grubunda laktat düzeyi, T1h, T2h ve Tpostop zaman dilimlerinde PVI düzeyi FT grubuna göre daha yüksek saptandı. PI'nin T2 zaman çerçevesinde önemli ölçüde düşük olduğu bulundu. Ameliyat sonrası yoğun bakıma yatış oranı NEA ve NE gruplarında daha yüksekti. Grup NEA'da yoğun bakımda kalış süresi grup NE'ye göre daha kısaydı.
Sonuç: Malign asitli over kanseri cerrahisinde perioperatif hemodinamik optimizasyon, doku perfüzyonu ve plazma onkotik basıncı sağlamak için albümin ile düşük doz NE kullanımını öneriyoruz. Bu hastalarda yüksek sıvı replasmanına rağmen norepinefrin ve albüminin birlikte kullanılması perioperatif dönemde majör komplikasyonları önlemede/azaltmada önemli rol oynayabilir.

Keywords

epitelyal ovaryan kanser, hemodinamik monitörizasyon, sıvı yönetimi, malign asit

Optimization of perioperative hemodynamics in cytoreductive surgery of ovarian cancer with malignant ascites

Abstract

Purpose: In this study, we aimed to evaluate the effects of norepinephrine and albumin use in patients with epithelial ovarian cancer with malignant ascite in order to maintain plasma oncotic pressure and intravascular volume, to provide perioperative hemodynamic stabilization and tissue perfusion. In addition, it was aimed to compare in terms of postoperative intensive care admission, hospital stay and complications.
Materials and Methods: A total of 66 patients, 38 with ascites and 28 without ascites, who underwent cytoreductive surgery for ovarian cancer were included in this study. PVI and invasive arterial monitoring of the patients were performed after hemodynamic stabilization (after the start of surgery) (T0). T0, 1st hour (T1) and 2nd hour (T2) and postoperative (Tpostop.) Ascites patients were composed of 3 subgroups which the ones received norepinephrine (NE) infusion, norepinephrine + albumin (NEA) infusion or only fluid therapy (FT). From the perioperative hemodynamic and laboratory data of the patients, tissue perfusion was evaluated with lactate, and hemodynamic status was evaluated with pleth variability index (PVI), perfusion index (PI) and mean arterial pressure (MAP).
Results: Demographic and clinical findings did not differ significantly between patients with and without ascites. Lactate level in NEA / NE group in Tpostop, PVI level in T1h, T2h and Tpostop time frames were determined higher than the FT group. PI was found to be significantly lower in the T2 time frame. The postoperative ICU admission rate was higher in the NEA and NE groups. The duration of ICU stay in group NEA was shorter than in group NE.
Conclusion: We recommend the use of low-dose NE with albumin to provide perioperative hemodynamic optimization, tissue perfusion and plasma oncotic pressure in surgery of ovarian cancer with malignant ascites. Despite high fluid replacement in these patients, the use of norepinephrine and albumin together may have an important role in preventing / reducing major complications in the perioperative period.

Keywords

Epitelial ovarian cancer, fluid-therapy, hemodynamic monitoring, malignant ascites

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