Research Of Volume Management Guided By Stroke Volume Variation On Elderly Patients Undergoing Colorectal Surgery

Objective To investigate the influence on prognosis of elderly patientsundergoing colorectal surgery with goal fluid therapy guided by SVV.Methods Sixty ASA II~III patients without gender limit aged60~81undergoing elective colorectal surgery were randomly divided into(group A) and control group (group B).All patients received generalanesthesia(midazolam0.05~0.1mg/kg, fentanyl3.0~5.0ug/kg,etomidate0.2~0.3mg/kg, cisatracurium0.2mg/kg) induction andmechanical ventilation after tracheal intubation. Volume management ofobservation group was guided by maintaining SVV in8%~12%. Incontrol group, the fluid infusion was estimated according to thetraditional transfusion maintaining CVP in8~10cmH2O. Intraoperativeinfusion of Lactated Ringer’s solution and HES(2:1) were administered inthe two group patients. Hemodynamic indexs were recorded at these timepoints: right before anesthesia induction (T1), right before skin incision(T2),right after opening peritoneum (T3), during intestinal anastomosis(T4), during closing abdominal cavity (T5). Operation time, amount ofintraoperative blood loss and blood transfusion was also noted. Infusionquantity and urine output were registered. Bun, Cr, Lac, Hct, Hb wereexamined the day before and after the operation. The dosage and the casenumber of using ephedrine, atropine, urapidil, esmolol were recorded.Fliud therapy of postoperative patients was guided by randomizedsurgeon.The time of exhaust and defecation, liquid intake time, solidintake time, postoperative hospitalization time and the postoperativecomplications were record.Results The general condition of two groups was no significantdifference (P>0.05). Intraoperative hemodynamic changes were withinthe normal range. no obvious difference was found between two groups.Intraoperative transfusion volume and urine output in group A was lessthan in group B(p<0.05). Colloid input, blood loss, the case number ofplasma and red blood cell suspension were no significant difference (p>0.05). Hb,Hct in both two groups and BUN in group B were lowersignificantly than those of preoperation (p <0.01). Postoperative Lac, Crin two groups and BUN in group A was no significant change (p>0.05).the case number of using ephedrine, atropine, urapidil, esmolol in twogroup was no significant change (p>0.05). The time of exhaust (p <0.01) and defecation (p <0.05) in group A was shorter than in group B. liquidintake time and solid intake time in group A was significantly shorterthan in group B (p <0.01). Postoperative hospitalization time was shorterin group A (p <0.01).The incidence of every postoperative complicationwas no statistical significance between two groups(p>0.05). But thetotal complication rate in group A was lower than in group B (p <0.05).Conclusion In elderly intestinal surgery, the fluid therapy guided bySVV can reduce intraoperative infusion, maintain stable hemodynamicsand effective tissue perfusion, be beneficial to the recovery of intestinalfunction, improve the prognosis.