The Effects Of GDFT On Cerebral Oxygen Saturation And Postoperative Cognitive Function In Patients Undergoing Oral And Maxillofacial Tumors Surgery

Objective:To study the effects of goal-directed fluid therapy on cerebral oxygen saturation and early postoperative cognitive function in patients with oral and maxillofacial tumors surgery.Methods:45 patients with oral and maxillofacial tumor surgery（ages 35 to 80 years old）were selected,randomly divided into 2 groups,routine infusion group（control group,n=22）and GDFT group（experimental group,n=23）.Fuild therapy of control group adopted the routine rehydration solution of the expert consensus（2014）on liquid therapy during the anesthesia operation of the Chinese medical anesthesiology chapter of 2014.Fuild therapy of experimental group was guided by the goal-directed fluid therapy with each stroke volume variation（SVV）.1 day（D₁）before operation,postoperative（D₂）,7 days after 3 days（D₃）for patients with Montreal Cognitive Assessment scale（MoCA）score,and 1 day before surgery（T₁）,30 minutes after the surgery（T₂）,one day after surgery（T₃）,two days after surgery（T₄）to detect IL-6,S100β,NSE concentration.Being recorded hemodynamic parameters at each time point:15 min after all patients induced（H₁）,surgery（H₂）at the beginning,after the start of 3 h（H₃）,at the end of surgery（H₄）.Being recorded and counted regional cerebral oxygen saturation（cerebral regional oxygen saturation,rSO₂）and arterial blood lactate level and total fluid intake,operation time and low blood pressure,low cerebral oxygen saturation cases,postoperative complications and postoperative hospitalization days within seven days.Results:A total of 45 cases were included in this study,and the last 36 cases were included in the statistical analysis for various reasons.Postoperative POCD incidence was about 27.78%,among which,2 cases（11.11%）in the experimental group and 11cases in the control group（44.44%）,and the difference between the two groups was statistically significant（P<0.05）.The results showed that the difference of MoCA score in the two groups was statistically significant（P<0.05）.MoCA scores of the two groups were not identical at different time points.With the increase of surgery time,MoCA scores of the two groups were not identical,and the decrease in the control group was more obvious.There were statistically significant differences in the amount of IL-6 and S100βin the perioperative period between the two groups（P<0.05）.IL-6 and S100βwere not identical in both groups at different time points,and the concentration of L-6and S100βin the two groups were not all the same with time,and the increase in the control group was more obvious.There was no significant difference in the concentration of NSE content between the two groups（P>0.05）.The concentration of NSE content of the two groups was basically the same at different time points.In the two groups of patients at different time points,the perfusion point was:rSO₂ and lactate levels were not identical（P<0.05）.The rate of change of rSO₂ and lactate was not the same with time（P<0.05）,and the fluctuation amplitude of the control group was large.Hemodynamic parameters of the two groups at different time points were not identical（P<0.05）.The changes of HR and MAP were not all the same with time（P<0.05）,with a large fluctuation amplitude in the control group.The total amount of liquid in the experimental group,the intake of sodium lactate and the incidence of hypotension were significantly lower than that in the control group（P<0.05）.The amount of succinyl gelatin in the experimental group was significantly higher than that in the control group（P<0.05）.There was no statistically significant difference in the amount of urine,blood loss and low rSO₂ in the two groups（P>0.05）.The incidence of nausea and vomiting in the postoperative group was significantly lower than that in the control group（P<0.05）,and there was no significant difference between the remaining complications and the number of days after surgery（P>0.05）.Conclusion:GDFT can stable the perioperative hemodynamic parameters of patients who with oral and maxillofacial tumors surgery,improve tissue organ microcirculation perfusion and oxygen supply and demand balance,maintain the perioperative patients and to reduce perioperative inflammatory reaction and brain damage,reduce the incidence rate of these patients postoperative complications and the incidence of early postoperative POCD.