Goal-Directed Fluid Therapy Effects On Bowel Movement Function In Patients With Gastrointestinal Tumor

Objectives Through the perioperative marked gastrointestinal surgery in the elderly patients with microcirculation blood flow dynamics, nutrition metabolism, electrolyte and galanin and neurotrophic factors-3 aspects, multi-angle analysis, explore perioperative goal-directed liquid treatment for gastrointestinal motor function in patients with senile gastrointestinal tumor surgery effect and application value.Methods 1 Sixty ASAⅡ Ⅲ patients, aged 65⁸0, male 38 cases, female 22 cases,undergoing elective radical operation for gastrointestinal tumor, were included from January 2015 to June 2015 in the affiliated Hospital of North China University of Science and Technology, were randomly into 2 group（n=30 each）, control group（C）,goal-directed group（G）. 2 Collect patients’ gender, age, height, weight, propagated, such as general data,recored the data; The intraoperative fluid management in control group was based on the MAP, CVP, urine output; Goal-directed group adopting the Flotrac/Vigileo, according to the SVV 、 CI 、 SVR 、 CVP 、 MAP. SVV < 13% as a goal to guide the rehydration,observe two groups of perioperative and postoperative hemodynamic, intestinal tract environment, nutrition metabolism, galanin, the NT-3 and gastrointestinal functional recovery, and so on. 3 Applyed the Flotrac/Vigileo systerm for monitoring patients with perioperative and postoperative SVV, CI, SVI, SVR. Compare the control group（C） and goal-directed group（G） MAP, CVP, HR, SVV, CI difference have statistical significance;Monitoring of perioperative blood gas, electrolyte and central venous oxygen saturation changes in group C compared with group G electrolyte and microcirculation oxygen supply for any difference; Enzyme league immune method for measuring serum galanin,NT-3 concentration, record exhaust time, postoperative evaluation in the two groups bowel movement function recovery. Postoperative fluid loss, rehydration, length of hospital stay,inquires into goal-directed liquid treatment for elderly marked gastrointestinal motor function recovery of patients with gastrointestinal tumor surgery. 4 Excel was used to establish a database, SPSS20.0 statistical analysis software was used for statistical analysis,all measurement data used by mean±standard deviation（（?）±s）.Group compared with repetitive measure analysis of variance, comparing with group T-test. Counting information were expressed as percent, their comparison used chi-squared test. Differences weresaid considered significanly at P<0.05.Results 1 Two groups of patients with surgery, gender, age, height, weight, ASA physical status and propagated general data difference has no statistical significance（P>0.05）, two groups of patients were generally comparable. 2 Two groups of 24 h of perioperative and postoperative hemodynamic compared with group C, group G postoperative 24 HR slowing, MAP, CVP increased（P<0.05）, suggesting GDFT lasting effectively maintain blood circulation to best ensure the stability of hemodynamics, good for gastrointestinal tissue perfusion;Surgery 1h SVV reduces, CI, Sv O2 increased 1 h, 24 h after the surgery; SVV, CI preoperative lower relatively（P<0.05）, suggesting goaldirected liquid treatment can increase the body’s oxygen supply, maintain the balance of gastrointestinal tract oxygen supply and oxygen consumption, reduce the risk of gastrointestinal mucosa ischemia hypoxia.3 Two groups of patients with intraoperative vascular active drug use, fluid intake and exhaust and hospitalization compared with group C, group G crystal liquid dosage decreased significantly, the dosage of colloid and urine increased significantly（P<0.05）. There was no statistically significant difference bleeding amount of two groups, group G with 3 cases of patients who used the vascular active drug, group C in 5 cases（P>0.05）. Group G exhaust, hospitalization were shorter than the control group（P<0.05）. Explained goal-directed liquid treatment compared with the traditional rehydration more accurately control in and out of the fluid, master the use of liquid crystal, colloid ratio, reduce perioperative incidence of gastrointestinal tissue edema caused by inappropriate transfusion, delay the recovery of gastrointestinal function, reduce the complications. Postoperative follow-up of patients with exhaust,length of hospital stay can be concluded that the application of GDFT can shorten the length of hospital stay, reduce medical costs, this is in line with the research results at home and abroad.4 In the two groups of perioperative blood gas electrolyte, galanin, NT-3 changes, compared with group C, perioperative group G Na +, K + concentration is high end of operation（P<0.05）, perioperative Ca2+ concentration didn’t changes.Explained liquid treatment affect the perioperative the change of the electrolyte, interference environment is stable in the gastrointestinal tract, postoperative hinder bowel movement function recovery as early as possible. In surgery began, surgery for 1 hour, end of the surgery, galanin was lower;The NT-3 was higher; With preoperative than galanin, NT- 3with increased with the extension of surgery time（P<0.05）, suggesting GDFT can lower the damage of surgical stress on the neuroendocrine system, so as to reduce gastrointestinal mucosa damage. Two groups of the operation three days electrolyte and fluid loss rehydration conditions, compared with group C, the operation on the second day Na⁺, K⁺ were higher（P<0.05）. Ca²⁺（P>0.05）. Compared with group C, fluid loss,replenishment quantity significantly fewer;Compared with the preoperative, two groups of loss of fluid volume increases with postoperative recovery,（P<0.05）.Goal-directed liquid treatment can be a certain degree of maintaining the ionic balance of gastrointestinal tract internal environment, reduce the dosage of postoperative fluid,promote the early resumption of gastrointestinal function.Conclusions 1 Goal-directed liquid treatment lasts effectively maintaining the stability of hemodynamics, the elderly to ensure gastrointestinal mucous membrane oxygen supply and demand balance. 2 Goal-directed liquid treatment can guide the selection of the liquid,so as to ensure the stability of perioperative and postoperative electrolyte, lay a foundation for the recovery of gastrointestinal function. 3 Goal-directed liquid treatment can reduce the surgical stress neuroendocrine system of gastrointestinal mucosa damage.4 Perioperative fluid management to avoid the inappropriate infusion on gastrointestinal perfusion inadequacy or edema, promote the intestinal exhaust, shorten the hospitalization time, medical energy saving.