Restricted intravenous fluid regime effects on immunological indicators of elderly patients operated for gastrointestinal cancer
高涛1 虞文魁1 李维勤1 李宁1 朱维铭1 张娟娟1 习丰产1 黎介寿1
南京军区南京总医院外科ICU
Background Some of recent researches indicate that perioperative fluid restriction leads to better preserved clinical data as well as reduced complication rate. But to date, no study has focused on the effects of perioperative fluid restriction on postoperative immune function. This study was initiated to determine whether fluid restriction results in improved immunological outcome of patients undergoing gastrointestinal surgery for cancer.
Methods 79 aged patients underwent restricted fluid regimen(R group) or standard fluid regimen(S group) were included in this prospective, randomized trial during 16 months. We determined the T-lymphocyte(CD3+, CD4+, and CD8+) by flow cytometry and expression of HLA-DR in monocyte, and compare the difference between two groups. Complication rate were compared between two groups, and the relationship between complications and immunological changes were analyzed.
Results e restricted intravenous fluid regimen significantly reduced perioperative intravenous fluid volume. Circulating CD3+T cells was observed depression in both groups, and was better-preserved under the restricted intravenous fluid regimen(media, R vs S; POD2,746 vs 480cell/μl, P=0.022;POD3,878 vs 502cell/μl, P=0.005;POD5, 892 vs 674cell/μl, P=0.042). Even though the HLA-DR expression in monocyte was decreased in both group, the expression was better preserved in R group(media, R vs S;POD1,66.20 vs 51.97%, P=0.029; POD2,68.19 vs 51.26%, P=0.039; POD3, 72.19 vs 57.45%, P=0.014; POD5,73.92 vs 60.46%, P=0.036).Complications of infection in group R is reduced compared with in group S(15% vs 27% ,P=0.04). The multivariate analysis suggested that perioperative CD3+T cell changes was associated with the development of postoperative complication(odds ratio=1.963,[95% CI], 1.019-3.782, P=0.044), and also the complications of infection(odds ratio=3.106,[95% CI], 1.302-7.406,P=0.011).
Conclusion ellular immunity is better preserved under perioperative fluid restriction regimen in elderly patients operated for abdominal cancer. Better-preserved cellular immunological function is associate with the low perioperative complication rate in fluid restriction regime group.
Methods 79 aged patients underwent restricted fluid regimen(R group) or standard fluid regimen(S group) were included in this prospective, randomized trial during 16 months. We determined the T-lymphocyte(CD3+, CD4+, and CD8+) by flow cytometry and expression of HLA-DR in monocyte, and compare the difference between two groups. Complication rate were compared between two groups, and the relationship between complications and immunological changes were analyzed.
Results e restricted intravenous fluid regimen significantly reduced perioperative intravenous fluid volume. Circulating CD3+T cells was observed depression in both groups, and was better-preserved under the restricted intravenous fluid regimen(media, R vs S; POD2,746 vs 480cell/μl, P=0.022;POD3,878 vs 502cell/μl, P=0.005;POD5, 892 vs 674cell/μl, P=0.042). Even though the HLA-DR expression in monocyte was decreased in both group, the expression was better preserved in R group(media, R vs S;POD1,66.20 vs 51.97%, P=0.029; POD2,68.19 vs 51.26%, P=0.039; POD3, 72.19 vs 57.45%, P=0.014; POD5,73.92 vs 60.46%, P=0.036).Complications of infection in group R is reduced compared with in group S(15% vs 27% ,P=0.04). The multivariate analysis suggested that perioperative CD3+T cell changes was associated with the development of postoperative complication(odds ratio=1.963,[95% CI], 1.019-3.782, P=0.044), and also the complications of infection(odds ratio=3.106,[95% CI], 1.302-7.406,P=0.011).
Conclusion ellular immunity is better preserved under perioperative fluid restriction regimen in elderly patients operated for abdominal cancer. Better-preserved cellular immunological function is associate with the low perioperative complication rate in fluid restriction regime group.
