Efficacy of goal-directed fluid therapy in improving the quality of early recovery on patients undergoing laparoscopic gynecological surgery
Objective To observe the efficacy of goal-directed fluid therapy(GDFT)in improving the quality of early recovery in the patients undergoing laparoscopic gynecological surgery.Methods A total of 90 patients undergoing laparoscopic gynecological surgery under general anesthesia were randomly divided into two groups of C and G with 45 cases each.The patients in group C underwent conventional fluid therapy strategy based on preoperative daily physiological requirement,preoperative fluid loss due to dietary restriction and preoperative cumulative fluid loss,intraoperative blood loss,compensatory vasodilation and third space loss in order to maintain intraoperative hemodynamic stability.The patients in group G received individualized GDFT strategy based on SVV and CI,which included keeping the SVV from 8%to 13%and CI from 2.5 to 4.0L·min-1·m-2.The intraoperative fluid intake and outflow and the use of vasoactive drugs were recorded and analyzed.The hemodynamic parameters such as HR,MAP,cardiac output(CO)and stroke volume(SV)were recorded before surgery(T0),10 minutes(T1)and 60 minutes(T2)after pneumoperitoneum,and at the end of operation(T3).The times for revival,recovery of bowel sound,first defecation and exhaust were recorded.The Quality of Recovery-40 Scale(QoR-40)and Insomnia Severity Index(ISI)were evaluated one day before surgery and 3 days after surgery,respectively.The incidence of postoperative complication was recorded.Results The requirements for crystalloid and total volume of fluid infused and vasoactive agents were lower in group G than those in group C,and the requirement for colloid was higher in group G than that in group C(P<0.05).The SV at T2 and CO at T2 and T3 in group G were higher than those in group C(P<0.05).The total QoR-40 score of group G was higher than that of group C,and the ISI score in group G was lower than that of group C(P<0.05).The incidence of postoperative nausea and vomiting in group G was lower than that in group C,the time of first bowel sound,first exhaust and defecation were shorter in group G than those in group C(P<0.05).Conclusion In the patients undergoing laparoscopic gynecological surgery,the GDFT strategy based on SVV and CI can effectively maintain the hemodynamic stability,reduce the incidence of postoperative nausea and vomiting,promote the recovery of postoperative gastrointestinal function,and improve the early postoperative sleep and recovery quality.