Effects Of Different Levels Of Stroke Volume Variation Directed Fluid Therapy On Short-term Prognosis In Elderly Patients

Objective To observe the effects of different levels of stroke volume variation (SVV) directed fluid therapy on short-term prognosis in elderly patients.Methods One hundred and ten patients (male 67 female 43)aged 60-80 years, ASA I-III undergoing abdominal surgeries were randomized into three groups on the basis of SVV level:11%<SVV<14%(Group H),7%<SVV<10%(Group M),3%<SVV<6% (Group L). Each group received constant infusion of crystalloid on 5ml/kg/ml. Meanwhile a bolus of 100ml/5min with crystalloid colloid ratio 1:1 was administrated to adjust the level of SVV. Perioperative oxygen delivery and consumption indicators were recorded, perioperative intake and outtake volume were recorded. Postoperative scores include Visual Analogue Scale (VAS), Quality of recovery score(QoR), Nausea and vomiting grading, Bruggrmann comfort scale on the first, third and fifth day after surgery were recorded. Prognosis indicators included gastrointestinal function recovery, post and total length of hospital stay and so on were collected. Postoperative complications were also recorded.Results Along with the level of SVV dropped, The volume of colloid and crystalloid among groups were significantly increased (p<0.05). From time Tl to T2, within groups, Central venous oxygen saturation (ScvO2) elevated in all groups, but the change was only statistically significant in Group M(p<0.05); Oxygen delivery index (DO2I) elevated in all groups, differences were statistically in both Group M&L(p<0.05); Oxygen consumption index (VO2I) declined in Group M and elevated in Group L, differences were statistically significant also(p<0.05). Among groups, the level of ScvO2 in Group M and DO2I in Group L on T2 were highest, differences were statistically significant while compared with the other two groups. The level of VO2I was lowest in Group M and highest in Group L, whereas the differences only in Group L were statistically significant compared with the other two groups(p<0.05).Group L had a delayed exhaust time compared with Group H(p<0.05). Patients in the Group M had a shortest time to have semi-liquid diet. The transition time of diet was also shortest in the Group M. But these differences were not statistically significant. The Group M also had a shortest time in first-degree or above nursing time and post/total length of hospital stay, the difference was significant compared with Group L(p<0.05). The morbidity of postoperative complications were similar among groups. The incidence of postoperative infection in Group L was higher than other two groups(p<0.05). Conditions of complications in Group L were more severe and complicated compared with other two groups. There were no significant differences in all four kinds of postoperative scores among groups.Conclusion 3%<SVV<6%may increase the risk of postoperative infection and prolong the time of hospitalization. Patients in the level of 7%<SVV<10% may have a better postoperative recovery. This level could be a better goal of perioperative fluid therapy in elderly patients.