The Influence Of Different Volume Levels On The Circulation And Postoperative Recovery Of Elderly Patients With Unilateral Total Knee Arthroplasty

Objective We aimed to investigate the influence of perioperative goal-directed fluid therapy (GDFT) guided by different levels of stroke volume variation (SVV) on the circulation and postoperative recovery of elderly patients with unilateral total knee arthroplasty (UTKA).Methods One hundred elderly patients (≥65 years old) who received UTKA and anaesthetized with nerve block combined with laryngeal mask anesthesia were enrolled in the current study. Selected patients were divided randomly into two groups, group A and group B. Reasonable volume treatment was performed to meet the requirements of SVVs, group A(4%< SVV≤9%) and group B(9%< SVV≤14%). The patients undergone hypotension after the release of the tourniquet would be intervened, those cases called cases M, and we recorded the proportion of cases M accounted for each of two groups (called M%). Recorded the liquid management during operation and postoperative 24h; Measured arterial blood gas analysis in preoperative and postoperative and recorded the C reactive protein (CRP) and interleukin 6 (IL-6) concentration in preoperative and postoperative 1,3,5 days. Main outcome measures were the number of complications (cardiac, respiratory, hepatic, renal, central nervous, infectious, et al).Results One hundred patients were included, fifty patients in each group. There was no significant difference in general information between two groups. Compared with group B, group A needed more fluid transfusion and had higher 24h urine volume. The incidence of tourniquet related hypotension intervention cases in group A was also lower than in group B(A group vs B group,44% vs 86%).The PaO2, the PaO2/FiO2-ratio and SaO2 before the end of the surgery in the group A were significantly lower than that of preoperative, but there were no differences between group A and group B.The CRP and IL-6 in group B were significantly higher than that in group A, For C reactive protein (CRP), Interleukin-6(IL-6), there were statistically significant differences between the preoperative and postoperative. Compared with group A, the CRP and the IL-6 was slightly elevated in the B group, and there were significant differences between two groups. The incidence of perioperative complications and POCD of group A was higher than that of group B, however, there were no significant differences between the two groups.Conclusion Sufficient blood volume (SVV≤9%) can reduce the incidence of hypotension after tourniquet release and can reduce the inflammatory reaction on the first day or the third day after surgery. However, the relatively high volume has a tendency to increase the incidence of perioperative complications (including postoperative cognitive dysfunction).