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開催概要
開催回
第58回・2020年・京都
 

傾向スコア分析を用いた食道癌手術における術中アルブミン輸液療法の有効性の検討

演題番号 : WS18-1

[筆頭演者]
羽田 綾馬:1 
[共同演者]
菊池 寛利:1、曽根田 亘:1、川田 三四郎:1、廣津 周:1、松本 知拓:1、森田 剛文:1、平松 良浩:1,2、神谷 欣志:1、竹内 裕也:1

1:浜松医科大学・第二外科、2:浜松医科大学・周術期生活機能支援学

 

(Background)Tachyarrhythmia is one of the most frequent status changes after transthoracic esophagectomy and a risk of hemodynamic instability. Hemodynamic instability could contribute to decrease blood perfusion to whole body organs. Stress to heart condition caused by dehydration and congestion provoke this condition. In our institute, we have routinely used intraoperative albumin administration to secure intravascular volume and reduce surplus crystalloid since 2018. In this study, we evaluated the effectiveness of albumin-combined fluid therapy. (Methods)Clinicopathological data of consecutive 156 patients who underwent transthoracic esophagectomy between January 2014 and March 2020, were retrospectively reviewed, and patients were classified into two groups; albumin combined fluid therapy group (A group) and non-albumin fluid therapy group (N group). One-to-one matching were performed between A and N groups based on the estimated propensity scores for each patient. (Results)After propensity score matching, each group included 44 patients respectively. The rate of superficial tumor and early clinical stage were significantly higher in A group than in N group (p=0.04, 0.02, respectively). The in-out balance of crystalloid during esophagectomy was significantly lower in A group (+4.75ml/kg/h vs +6.86ml/kg/h, p<0.05), whereas that of total fluid was comparable between the groups (+6.98ml/kg/h vs +7.04ml/kg/h, p=0.9). The incidence of postoperative low blood pressure and the use of vasopressor were significantly lower in A group than N group (25% vs 59.1%, p<0.05 and 6.8%, 34.1%, p<0.05, respectively). There was no statistical significance between the groups in postoperative tachyarrhythmia (18.2% vs 36.4%, p=0.09).
(Conclusions)Intraoperative albumin-combined fluid therapy is useful to inflate intravascular volume and to maintain blood pressure, which may contribute to hemodynamic stability after esophagectomy and prevent postoperative tachyarrhythmia.

キーワード

臓器別:食道

手法別:手術療法

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