Effect Of Goal-direced Fluid Therapy Based On NICOM On Prognosis In Elderly Patients Undergoing Resection Of Gastrointestinal Tumor

Objective:To investigate the effect of goal-directed fluid therapy based on NICOM on prognosis in elderly patients undergoing resection of gastrointestinal tumor.Methods: Fifty patients of both sexes,aged 65-90 years,of ASA physical status II or III, scheduled for elective laparoscopic radical resection for stomach, colon or rectal cancers, were included and randomly divided into two groups: conventional fluid therapy( group C, n=25) and goal-directed fluid therapy( group G, n=25).Group G receive goal-directed fluid therapy based on SVV and CI under the monitoring of NICOM, whereas group C receive conventional fluid therapy based on CVP, MAP and urine volume. The variation of MAP, HR, CVP, CI and SVV were recorded every ten minutes since entering the operation room. SCVO2, blood lactate concentration, MAP, HR, CVP, CI and SVV were recorded at the onset of the monitoring(T1) and the end of the surgery(T2). The duration of surgery, the duration of CO2 pneumoperitoneum, fluid intake and output during operation, the requirement of vasoactive agents, the time for removal of the endotracheal tube, the time when the patients passed the flatus,the postoperative complications within 30 days and the length of hospital stay after operation were also recorded.Results: Compared with group C, the requirement of crystalloid and the total volume of fluid infused were significantly decreased, while the requirement of colloid was increased in group G. There were no difference of the duration of surgery, the duration of CO2 pneumoperitoneum, the requirement of vasoactive agents, the bleeding volume and the blood transfusion volume between two groups. Compared with group C, the MAP and the mean CI were higher, the mean SVV was lower in group G. There were no difference of MAP, HR, CVP and CI between two groups at T1.CVP and CI in both two groups,blood lactate concentration in group C and SCVO2 in group G were higher at T2 than that at T1. At T2, SCVO2 was much higher and blood lactate concentration was much lower in group in group G than that in group C. Compared with group C, the time when the patients passed the flatus and the length of hospital stay after operation were shortened, the incidence of postoperative complications were lower in group G.Conclusion: Goal-directed fluid therapy based on NICOM can significantly enhance the hemodynamic stability intraoperatively and improve prognosis effectively in elderly patients undergoing resection of gastrointestinal tumor.