Influence Of Goal-directed Fluid Therapy On Complications After Gastric Cancer Surgery In Elderly Patients With Hypertension

Objective:To explore the influence of perioperative goal-directed fluidtherapy (GDFT) on complications after gastric cancer operation in elderlypatients with hypertension.Methods:A total of60elderly patients aged over65with primaryhypertension, who was classified as American Society ofAnesthesiology(ASA) class Ⅱ～Ⅲ and underwent gastric cancer radicalsurgery, were selected. They were randomly divided into conventionalintraoperative fluid management group (group C, n=30) and GDFT group(group G, n=30). Patients in group C were infused with crystalloids orcolloids according to Miller’s Anesthesia (6thedited).Patients in groupG were infused with200ml hydroxyethyl starch in15min under theFloTrac/Vigileo monitoring system with controlling of8%＜stroke volumevariation (SVV)＜13%. Hemodynamics and tissue perfusion laboratoryindicators of all patients were observed and recorded respectively at30min before the operation (T0), the beginning of the operation (T1),1h afterthe beginning of operation (T2), the end of the operation (T3),6h afterthe operation (T4),12h after the operation (T5) and24h after the operation(T6).Intraoperative intake,vascular active drugs, postoperat-ivecomplications with in30days, and hospital stay after operation were alsorecorded.Results:Compared with those of group C and group G, intraoperativeintravenous infusion quantity was significantly reduced [(2732±488) vs (3135±346)ml,P<0.05],while its colloid fluid volume was larger[(1235±360)vs(760±280)ml,P<0.05],intraoperative and postoperativehemodynamics was more stable, the occurence of low blood pressure was less.Besides, at the end of the operation and24h after the operation, thecentral venous oxygen saturation (ScvO2) in group G was significantlyincreased. Its serum lactic acid (Lac) concentration remained stable atthe end of the surgery and12h after the surgery. Earlier first exhausttime[(4.3±1.9)vs(3.6±1.4)d,P<0.05] and shorter stay of postoperativeinpatients [(10.8±1.9)vs(12.2±2.4)d,P<0.05] were also observed inGroup G. No significant difference in mortality and major complications,such as intestinal anastomotic fistula, was observed between the twogroups.Conclusions:GDFT can stabilizes perioperative hemodynamics, reduce theoccurrence of postoperative complications, and improve the prognosis ofpatients in eldly hypertensive patients with gastric cancer surgery.