Establishment And Evaluation Of Elderly Coronary Heart Disease Patients Undergoing Surgery Of The Individual Capacity Of Treatment Programs

Objective:To assess goal-directed fluid management prevent gastrointestinalcomplications in major surgery.Methods:We electronically searched Cochranelibrary(Issue3,2010)Pubmed、EMbase、Highwire、CBM、CNKI.The search wasJanuary2000to December2010.Randomized controlled trials (RCTs) wereindentified about goal-directed fluid management reduces gastrointestinalcomplications. Study selection and meta-analysis were conducted which accordingto the Cochrane Handbook for systematic reviews. Date were extracted from thesetrials by3reviewers independently and analyzed by RevMan5.0software.Results:Ten trials involving775patients were included. Meta-analysis indicatedthat, goal-directed fluid management than the control group using more the colloid.[WMD=-630.66,95%，CI(144.20,1117.13)], and oxygen delivery [WMD=82.95,95%CI(17.43,148.46)]. Goal-directed fluid management in Perioperative can reducepostoperative hospital stay [WMD=-2.06,95%CI(-2.95,-1.17)] and reduce the rateof postoperative complications in major surgery [RR=0.39,95%CI(0.29,0.52)].Conclusion:The current evidence shows that goal-directed fluid management canprotect organ functions particularly at risk of perioperative hypoperfusion, decreasethe incidence of postoperative complications, and may contribute to improvesurvival after major surgery. Objective：To assess the efficacy of goal-directed fluid therapy in coronaryheart disease Patients undergoing gastrointestinal surgery and to establish theindividual and target fluid therapy.Methods：In this randomized, controlled trial60coronary heart disease patients scheduled for gastrointestinal surgery were included.Patients were allocated into either an Goal-directed intraoperative therapy groupusing CI,SVV,SVI,based intraoperative optimization protocol (FloTrac/Vigileodevice, GDT-group, n=30) or a standard management group (Control-group, n=30).In addition, received intraoperative plasma volume expansion guided by(FloTrac/Vigileo) monitor to maintain maximal SV. HR,SpO2,MAP,PVI,DO2I,Electrocardiogram were noted respectively in entering-room(T1), intubation (T2),beginning operation (T3), Surgery for1hour(T4), end of surgery (T5),Length ofpostoperative hospital stay, major adverse cardiac events were assessed. Results:Preoperative volume status was no significant difference in two groups patients. Primaryoutcomes: The incidence of arrhythmia in the GDT-groups were much lower thancontrol group （16%VS23%,p<0.05）,overall adverse cardiac events wassignificantly less than control grou（p36.7%VS56.7,p<0.05）. Secondary outcomes:Compared with the Control-group,CI in postinduction (T5)was significantlyincreased （4.13±0.42VS3.71±0.42，P<0.05）. In control group at postoperatively(T5)moment serum lactate levels is significantly increased（0.98±0.36mmo/L VS3.71±0.42mmo/L, P <0.05) than control group.other outcomes: Significantly morecolloids were administered in the GDT group (1012±221ml VS825±249ml,p<0.05), whereas the amount of crystalloid volume replacement was lower (1510±313ml VS2315±318ml，p<0.05). The mean of hospital stay was significantly reduced in theGDT-group with (18±4)days versus (26±6)days (P<0.05) and fewer patientsdeveloped complications than in the Control-group. Conclusions: In coronary heartdisease Patients undergoing gastrointestinal surgery, implementation of anintraoperative goal directed hemodynamic optimization was associated with areduced length of hospital stay and a lower incidence of complications compared toa standard management protocol.