Effect of goal-directed fluid therapy on perioperative period of elderly patients undergoing laparoscopic radical resection of rectal cancer
Objective:To explore the effect of the goal-directed fluid therapy guided by cardiac index(CI)and stroke volume variation(SVV)on perioperative period of elderly patients undergoing laparoscopic radical resection of rectal cancer.Methods:From Apr.2023 to Aug.2023,70 elderly patients who underwent laparoscopic radical resection of rectal cancer were selected and randomly divided into conventional infusion group(group C)and goal-oriented group(group G),with 35 patients in each group.Among them,group G was given target-oriented fluid therapy guided by CI and SVV,while group C was given conventional fluid therapy guided by mean arterial pressure(MAP)and central venous pressure.The operation-related indexes(total fluid volume,crystal volume,colloidal volume,urine volume,blood loss and operation time)were compared between the two groups.The heart rate and MAP of two groups were recorded at the time before anesthesia induction(T1),5 min after tracheal intubation(T2),5 min after changing position(T3),60 min after changing position(T4),5 min after pneumoperitoneum end(T5),and the end of surgery(T6).The pH values and arterial lactate(aLac)levels of both groups were recorded at T1,T4,T6.The restlessness index of two groups were recorded at T1 and 5 min after extubation(T7),and the occurrence of complications in anesthesia resuscitation room was recorded.The heart rate and MAP on the first day,the third day and the seventh day after operation and the occurrence of postoperative complications were recorded.Results:Compared with group C,the total amount of colloidal fluid infused during surgery in group G increased,while the total amount of crystal-line fluid decreased(P<0.05).At time T3 to T6,the MAP of group G was higher than that of group C(P<0.05);the MAP of group C from T2 to T6 was lower than that of the same group at Tl(P<0.05),while in group G,except for the lower MAP at T2 and T6(P<0.05),there was no difference in MAP between T3 to T5 and T1(P>0.05).At T6,the pH value of group G was higher than that of group C,while the aLac value was lower than that of group C(P<0.05).The aLac value of group C at T6 was significantly higher than that of the same group at T1(P<0.05).The restlessness index in group G was lower than that in group C at T7(P<0.05).The incidence of postoperative complications such as nausea and vomiting,infection,anastomotic leakage and intestinal obstruction in group G(8.57%)was lower than that in group C(28.57%).Conclusions:Goal-directed fluid therapy guided by CI and SVV can optimize intraoperative hemodynamic indicators,improve tissue perfusion,alleviate discomfort during anesthesia recovery period,and reduce the incidence of postoperative complications in elderly patients undergoing laparoscopic rectal cancer radical surgery.
Rectal neoplasmsRadical resection of rectal cancerLaparoscopyGoal-directed fluid therapyAged
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