Effect Of Different Targets Of Goal-directed Fluid Therapy On Perioperative Immune Function In Elderly Patients Undergoing Laparoscopic Radical Colorectal Cancer Surgery

Objective To evaluate the efficacy of different targets of goal-directed fluid therapy(GDFT)on the perioperative immune function in elderly patients undergoing laparoscopic radical colorectal cancer.Methods Eighty American Society of Anesthesiologists physical status ⅠI or IⅡ patients,aged 65~79 years,and with body mass index of18~25 kg/m2,scheduled for elective laparoscopic radical colorectal cancer,were selected.They were divided into two groups using a random number table method: 9%≤SVV<14%(group H)and 4%≤SVV<9%(group L),40 in each group.All patients were connected with Most-Care monitoring system through radial puncture and intubation.At the same time,continuous monitoring of stroke volume variation(SVV),cardiac index(CI),mean arterial pressure(MAP)were recorded.Internal jugular venipuncture was performed to monitor central venous pressure(CVP).Maintaining 9%≤SVV<14% or 4%≤SVV<9% as the goals,combined with CI for GDFT.The colloid fluid dosage,crystal fluid dosage,total infusion,urine volume,blood loss and the use of vasoactive drugs during the operation were recorded.SVV,CI,MAP,CVP were recorded at the moment establishment monitoring(T0),before induction(T1),immediately after induction(T2),after pneumoperitoneum establishment(T3),after specimen resection(T4)and the end of the surgery(T5).The arterial blood gas analysis and the venous blood gas analysis were performed at T0 and T5.Venous blood were drawn at T0,T5,T6(1 day after surgery),T7(5 days after surgery),and flow cytometry were applied to detect the percentage ofT-lymphocyte subsets,including CD3+,CD4+,CD8+,and CD4+/CD8+.ELISA was used to measure the serum levels of interleukin 6 and the serum levels of interleukin 10(IL-6,IL-10).The first postoperative exhaust and postoperative hospital stay,nausea,vomiting,anastomosis,and postoperative infection were recorded.Results1 Comparison of the volume of fluid in and out and the use of vasoactive drugs in two groups: Compared with group L,the total infusion volume,the amount of crystal fluid and colloidal fluid,the urine volume of the group H were significantly reduced,the frequency of use of vascular active drugs during the operation were increased(P<0.05).There was no significant difference in blood loss in the two groups(P> 0.05).2 Comparison of intraoperative hemodynamic indicators in two groups: Compared with the group L,the SVV of the group H was increased at the points of T1-5,the CVP of the group H was decreased at the points of T4-5(P<0.05).3 Comparison of blood gas analysis in two groups: Compared with T0,Scv O2,DO2 I,VO2I,and ERO2 at the point of T5 were increased in the two groups(P<0.05).Compared with the group L,the Scv O2 of the group H was increased,the DO2 I,VO2I,ERO2 of the group H were decreased at the point of T5(P<0.05).4 Comparison of immune function in two groups: Compared with T0,the CD4+/CD8+ was decreased at the points of T5-6 in the two groups,the CD4+/CD8+ was increased at the point of T7 in the two groups(P<0.05).Compared with the group L,the CD3+ and CD4+/CD8+of the group H were increased and the CD8+ was decreased at the points of T5-7(P<0.05).5 Comparison of inflammation indicators in two groups: Compared with T0,the IL-6 and IL-10 in serum in two groups were increased at the points of T5-7(P<0.05).Compared with group L,the IL-6 in serum of thegroup H was decreased at the points of T5-7,IL-10 in serum of the group H increased at the points of T5-7(P<0.05).6 Comparison of postoperative recovery and postoperative complications in two groups: Compared with the group L,the first exhaust time after surgery and the time of hospital stay after surgery of the group H were shortened(P<0.05).There were no significant differences in the incidence of nausea,vomiting,anastomotic fistula,and postoperative infection(P> 0.05).ConclusionCompared with the GDFT of 4%≤SVV<9%,maintaining SVV at9%≤SVV< 14% is more helpful to improve the perioperative immune function of elderly patients undergoing radical colorectal cancer surgery and can reduce inflammation response and can shorten the length of hospital after surgery and help to improve the prognosis of patients.