Effects Of Different Liquid Therapies On Perioperative Immune Inflammatory Response And Early Cognitive Function In Elderly Patients Undergoing Total Hip Replacement Surgery

Objective To compare and observe the effects of different fluid therapies（restrictive fluid therapy,open fluid therapy and goal-directed fluid therapy）on the circulatory status,immune inflammatory response and early cognitive function of elderly patients undergoing total hip replacement surgery.In order to provide clinical evidence for elderly patient received liquid therapy undergoing total hip replacement.Methods Sixty elderly patients of elective total hip replacement were divided into 3groups:restricted fluid therapy group（group R）,liberal fluid therapy group（group L）,goal-directed fluid therapy group（group G）.Group R and L received fluid base on MAP（>65 mm Hg）and CVP（5～12 mm Hg）.Group G were treated under GDFT strategy with a target of SVV<13%,CI>2.5 L·min^-1·m^-2,MAP>65 mm Hg.Record patient’s vital signs（HR,MAP,CVP,SpO₂）of three groups before induction of anesthesia（T₁）,1 hour after the operation（T₂）,immediately after the surgery（T₃）,and at the time of leaving the anesthesia recovery room（T₄）;and arterial blood was drawn from patients at T₁,T₂,T₃,and T₄ for blood gas analysis.5 ml venous blood was drawn from three groups of patients,at 1d before surgery（T₀）,1d after surgery（T₅）,3d after surgery（T₆）,and 7d after surgery（T₇）,and concentrations of serum inflammatory factors（TNF-α,IL-1β,IL-6,IL-10）and brain damage protein（S-100βprotein,tau protein,neurofilament light chain）were detected by ELISA.And at T₀,T₅,T₆,T₇,the MMSE scale was used to evaluate the cognitive function of patients.Results There were no significant differences in sex,age,and ody mass index between3 groups（P>0.05）.The total amount of liquid input and the amount of crystals and colloidal fluid in group G is higher than group R,but lower than group L（P<0.05）.At T₂ and T₃,the MAP in group G was significantly higher than that in groups R and L（P<0.05）.At T₂,T₃,and T₄,the Lac of group G was significantly lower than group R and L（P<0.05）.At T₅,T₆,concentrations of TNF-α,IL-1β,IL-6,S-100β,tau protein and neurofilament protein in group G were significantly lower than group L and R（P<0.05）,concentrations of IL-10 and MMSE score of group G were significantly higher than group L and R（P<0.05）.At T₇,concentrations of S-100β,tau protein and neurofilament protein in group G were significantly lower than group L and R（P<0.05）,concentrations of IL-10 and MMSE score of group G were significantly higher than group L and R（P<0.05）.Conclusion Goal-directed fluid therapy can provide better hemodynamic stability and tissues perfusion during anesthesia,reduce the postoperative inflammatory response and the risk of early cognitive dysfunction after total hip replacement in the elderly.