Effect Of Two Intraoperative Fluid Therapys On Postoperative Recovery In Elderly Patients Undergoing Elective Abdominal Surgery

Objective To compare the effect of a goal-directed fluid therapy versus a standard regimen on postoperative recovery in elderly patients undergoing elective abdominal surgery.Methods Forty patients (ASA physical statusⅠ～Ⅱ) aged 65～80 years, undergoing elective abdominal surgery with general anesthesia were randomized to either a standard group/group A(n=20)or a goal-directed therapy group/group B(n=20).The day before surgery, all patients received conventional bowel preparations. Entering operating room, all patients received continuous monitoring:ECG, Heart Rate(HR), pulse oxygen saturation(SPO2), invasive and noninvasive blood pressure. Use unified target controlled infusion (TCI): Anesthesia was induced with propofol and remifentanil, with effect compart-ment concentration 3ug/ml and 5ng/ml respectively, administered by a TCI system (Diprifusor). After the patient losing consciousness, give the patient vecuronium 0.1mg/kg.The muscle relaxant effecting is the time for endotracheal intubation. After endotracheal intubation, until blood pressure and heart rate returning to normal range, adjust effect compartment concentration of propofol and remifentanil to 2ug/ml and 1ng/ml, every 30min give vecuronium 0.05mg/kg.During the operation, according with blood pressure and heart rate, adjust the infusion rate of propofol and remifentanil. Intraoperative fluid infusion of Group A was given according with Miller's Anesthesia (6th ed). Amount of Lactated Ringer's solution were administered in B group patients at the rate of 4 ml/(kg-h). Group B Depending on the indicators of intraoperative monitoring, intraoperative fluid infusion of Group B was adjusted to achieve HR 60～100times/min, MAP 65-90mmHg, CVP 6～12cmH2O, urine output≥0.5ml /(kg·h), Hb≥100g/L or Hct≥30%. And postoperative fluid regimen is followed the model as usual. Record the result of preoperative, intraoperative and postoperative arterial blood pressure, heart rate, CVP, urine output, blood gas analysis and the time of extubation. And the first day of blood routine, liver and kidney function, electrolytes, blood gas analysis, and the first time of exhaust, postoperative hospitalization time, postoperative complications was recorded.Results 1.At the end of the operations, the intraoperative volume of fluid administered were significantly higher in the group A than those of group B (2705±570ml vs 1955±756ml)(P<0.05).2.Compared with the group A, the off-line (1.12±0.55h vs 0.78±0.48h) (P<0.05)and extubation time (2.07±0.85h vs 1.54±0.73h) (P<0.05)of group B was significantly shorter than group A.3. In the first postoperative day, oxygenation index, hemoglobin and albumin concentrations were significantly higher in the group B compared with the group A (P<0.05).4. Patients in the group A passed flatus were significantly later than Group B patients did (4.0±0.9d vs3.4±0.9d) (P<0.05).5.The incidence of postoperative complications in the group B were significantly lower compared with the group A (35% vs 15%) (P<0.05).6.The duration of hospital stay was longer in the group A (15.0±3.5d vs12.8±2.9d)(P<0.05).Conclusion 1.Goal-directed fluid therapy can maintain hemodynamics stablely and urine output within the normal range in elderly patients undergoing elective abdominal surgery.2. Goal-directed fluid therapy may be advantageous in postoperative pulmonary oxygenation and reducing the extubation time in elderly patients.3. Goal-directed fluid therapy is beneficial to the recovery of gastrointestinal function and wound healing, and shorten the hospital stay period in elderly patients.