Effect Of Goal-Directed Fluid Therapy Directed By SVV On Intestinal Barrier Function And Postoperative Recovery Quality Of Patients Undergoing Laparoscopic Radical Resection Of Gastric Cancer

PurposeThe study was carried out to observe the changes in intestinal barrier function and postoperative recovery quality of patients undergoing laparoscopic radical resection of gastric cancer,which was treated with perioperative fluid therapy guided by SVV,and to explore its application value in patients undergoing gastric cancer surgery,in order to provide clinical evidence.MethodsSixty patients who underwent elective laparoscopic radical resection of gastric cancer were randomly divided into 2 groups:Group G(observation group,n=30)was treated with Goal-directed Fluid Therapy guided by SVV and Group C(control group,n=30)with conventional fluid therapy.All patients used rapid induction of anesthesia to endotracheal intubation and control respiratory.Anesthesia was maintained with intravenous infusion of propofol、remifentanil、cisatracurium besilste and dexmedetomidine and inhalation of sevoflurane.Length of surgery,total volume of fluid infused,volume of crystalloid and colloid fluid infused,bleeding volume,urine volume,doses of propofol、sufentanil、remifentanil、cisatracurium besilste and the use of vasoactive drugs were recorded.The values of MAP、HR、SVV、CO and CI were recorded before anesthesia(T0),at the beginning of surgery(T1),5 minutes after pneumoperitoneum(T2),30 minutes after pneumoperitoneum(T3),2 hours after surgery(T4),at the end of surgery(T5)and at the exit of PACU(T6).Levels of I-FABP、D-lactic and arterial Lac were recorded before anesthesia(t0),at the end of surgery(t1),1 day(t2)and 3 day(t3)after surgery.The patients were followed up after surgery,and exhaust time,postoperative hospital stay time,postoperative cardiovascular complications,pulmonary complications and renal function impairment were recorded.QOR-40 scale was used to evaluate the recovery of patients by anesthesiologists who did not know the grouping at 1 day before surgery(QOR40-pre),1 day after surgery(QOR40-POD1),and 3 days after surgery(QOR40-POD3).Results(1)There were no significant differences in the demographic data(sex、age、ASA、BMI and duration of surgery)between the two groups(P>0.05).(2)Primary outcome:The comparison of the levels of D-lactic and I-FABP in two groups① The levels of D-lactic and I-FABP were no significant differences in two groups at t0(P>0.05),but the levels of D-lactic and I-FABP were significantly higher in Group C than in Group G at t1～t3(P<0.01).② Compared with t0,the levels of D-lactic and I-FABP were significantly higher at t1～t3 in two groups(P<0.01);the level of I-FABP in Group C and the level of D-lactic in Group G were significantly higher at t2(P<0.01).Compared with t2,the levels of D-lactic and I-FABP were significantly lower in two groups at t3(P<0.01).(3)Secondary outcome:There were no significant differences in the incidence of postoperative pulmonary complications,cardiovascular complications and renal function impairment(P>0.05).The exhaust time and postoperative hospital stay time were significantly shorter in Group G than in Group C(P<0.01).(4)Secondary outcome:There was no significant difference in the score of QoR40-Pre between two groups(P>0.05).The score of QoR40-POD1 and QoR40-POD3 were significantly higher in Group G than in Group C(P<0.01).The score of QoR40-POD1 was significantly lower than the score of QoR40-Pre in two groups(P<0.01).The score of QoR40-POD3 was higher than the score of QoR40-POD1(P<0.01),but lower than the score of QoR40-Pre(P<0.01).(5)There was no significant difference in the value of arterial Lac at t0、t2 和 t3 between two groups(P>0.05).The value of arterial Lac was significantly lower in Group G than in Group C at t1(P<0.05).(6)The volume of crystalloid and colloid fluid and total volume of fluid infused were significantly lower in Group G than in Group C(P<0.05).The required doses of anesthestics,bleeding volume,urine volume,incidence of blood transfusion and vasoactive drugs were no significant differences(P>0.05).(7)The comparison of hemodynamic indicators in two groups①At T0～T6,MAP and HR were no significant differences in two groups(P>0.05).②At T5,SVV was significantly lower in Group G than in Group C(P<0.05).③Compared with T0,SVV was significantly higher at T1～T3(P<0.01)and significantly lower at T4-T5 in two groups(P<0.01).④ At T5 and T6,CI and CO were significantly higher in Group G than in Group C(P<0.05).⑤Compared with T0,CI and CO were significantly lower at T1～T6 in Group C(P<0.01);CI and CO were significantly lower at T1～T4 in Group G(P<0.01).ConclusionsGoal-directed Fluid Therapy under the guidance of SVV can provide personalized and accurate fluid therapy strategies for patients undergoing laparoscopic radical resection of gastric cancer.It can maintain hemodynamic status,high cardiac output and index by less appropriate amount of fluid,which ensures tissue and organ perfusion,protects intestinal barrier function,avoids excessive infusion and promotes rapid postoperative recovery.