Comparison Of The Prognosis Of Norepinephrine And Phenylephrine On Colorectal Cancer Surgery During SVV Fluid Guided Therapy In Elderly

Purpose: Stroke volume variation(SVV)is an accurate,convenient parameter for measurement of liquid reactivity.It is also a functional hemodynamic parameter.With the aging of the population,an increased number of elderly patients need major surgery.Fluid management is the first-line in the treatment strategy,however,is often not enough to stabilize the patient’s condition,especially in elderly patients,due to the decline in cardiovascular function in elderly patients,and preoperative fasting,preoperative gastrointestinal preparation and the inhibitory effects of cardiovascular drugs.All of this may lead to more hemodynamic fluctuations during operation and to increased perioperative risk.Related literature shows that due to restrictive transfusion in elderly patients,hypotension may occur that is why prophylactic administration of small doses of norepinephrine,can effectively increase the supply of oxygen,and can reduce the incidence of postoperative complications,no obvious adverse effects on gastrointestinal tract microcirculation and oxygen consumption have been found.Intraoperative anesthetic drugs may induce clinical effects on vascular dilatation.Therefore,we usually give phenylephrine to correct hypotension and increase peripheral vascular resistance.It can slow the heart rate and reduce myocardial oxygen consumption.We conducted this prospective randomized double-blind study,in order to compare the prognosis in elderly patients undergoing SVV guided fluid therapy of norepinephrine and phenylephrine and,to find a feasible perioperative fluid therapy optimization.Methods: The objects of this study were undergoing knot(straight)resection of colorectal cancer patients.According to the random number table method were randomly divided into norepinephrine(5 g/ml)group and phenylephrine(100 g/ml)group,20 cases in each group.Patients in local anesthesia for radial artery puncture manometry,and connect FloTrac / Vigileo monitoring SVV,cardiac index(Cardiac index,CI),cardiac output(Cardiac,output,CO)and other indicators,local anesthesia for central venous puncture,connecting venous access and monitoring central venous pressure(Central venous,pressure,CVP).The liquid background infusion rate during 5ml/kg.h,according to the SVV regulation the liquid infusion rate and type.If the blood pressure lower than the baseline value of 20%,while pumping norepinephrine or phenylephrine.Background input two kinds of vasoactive drugs as the main observation index: 5ml/h.for renal function after operation,duration of ICU stay,mechanical ventilation in ICU Time,hospitalization costs,the first day of II evaluation of acute physiology and chronic health after surgery(APACHE II)score,exhaust time,hospitalization time,postoperative complications,28 day patient readmission rate and mortality.Secondary outcome measures: in the burglary,smooth,after the arterial puncture before anesthesia,intubation,after intubation 3min,the operation began,the end of operation and after the operation started every 30 min record the basic situation of patients(Bp,HR,SpO2,ABP,CO,SVV,CI,SV,CVP,Bis,ETCO2,T),intraoperative use of vasoactive drugs(ML),and whether the use of dobutamine butylamine,surgery in the urine,use of diuretics,crystal amount,the amount of colloid infusion,other liquid intake and intraoperative blood loss,intraoperative anesthesia time.Results: Liquid therapy in the SVV orientation,norepinephrine and phenylephrine on colon cancer radical(straight)prognosis observation index and postoperative observation index of patients in operation were not statistically significant.The two groups were Bp,HR,SpO2,ABP,CO,SVV,CI,SV,CVP,Bis ETCO2,T,intraoperative use of vasoactive drugs(ML),and whether the use of dobutamine,intraoperative urine volume,diuretic use,amount of crystal,the amount of colloid infusion,other liquid intake and intraoperative blood loss in the operation,the time of anesthesia were not statistically significant(P >0.05).The two groups in postoperative renal ICU,duration of ICU stay,mechanical ventilation time,hospitalization cost,exhaust time,hospitalization time,postoperative complications,28 day patient readmission rate and mortality rate were not statistically significant(P>0.05).The phenylephrine group postoperative APACHE II score than norepinephrine group lower.The two groups had significant difference(P= 0.048).This and phenylephrine group at ICU time of mechanical ventilation,ICU ventilation time phenylephrine group averaged 2.8 h,and ICU to norepinephrine group average ventilation time was 4.9 h,so the phenylephrine group accelerated ICU extubation time,and postoperative complications and tissue oxygenation without the obvious difference,so phenylephrine is a good,can be used for vasoactive drugs during operation.Conclusion: The application of phenylephrine in patients with heart dysfunction is also a good choice in prognosis compared to norepinephrine since we had no obvious difference between the two drugs.