Effects Of Goal-directed Haemodynamic Management Combined With Dexmedetomidine On Postoperative Outcome In Elderly Fragile Cardiac Function Patients Undergoing Abdominal Surgery

Objective The prognosis of elderly patients with fragile cardiac function has been paied more and more attention,because many elderly patients are often combined with cardiac dysfunction.The goal-dircted haemodynamic management based on SVV,CI and MAP is to optimize the patient's cardiac preload,myocardial contractility,afterload,which can improve the patient's cardiac function.Dexmedetomidine can reduce sympathetic activity,antiarrhythmia and ischemic reperfusion injury,inhibitting the adverse effects to cardio vascular from surgery and anesthesia.The aim of this study was to investigate the effect of goal-directed haemodynamic management combined with dexmedetomidine on the postoperative outcome in elderly patients with fragile cardiac function undergoing gastrointestinal surgery.Methods One hundred and sixty elderly patients with fragile cardiac function,aged65-90 year,not limited sex,ASA ? or ?,NYHA ? or ?,scheduled for selective gastroenteric surgical procedures were enrolled in this study.The patients were randomly assigned to four groups: Experience anesthesia group(group,n = 40),dexmedetomidine and experience anesthesia group(or we called hybrid group,H group,n = 40),goal-directed hemodynamic management group(G group,n = 40)and dexmedetomidine combined with goal-directed hemodynamic management group(D group,n = 40).In group H and D,dexmedetomidine with a loading dose of 0.4?g·kg-1was intravenously infused in 15 minutes before anesthesia induction,and continued with intravenous injection at 0.4 ?g·kg-1·h-1via a pump untill 30 minutes before the end of surgery.While in group E and G,equal volume of 0.9% saline was given.In group G and D,the SVV and CI were monitored by Vigileo,and adjust the preloaded infusion fluid,positive inotropic drugs and positive pressure drugs according to SVV(?12%),CI(?2.5L·min-1·m-2)and MAP(maintain the base value of±20%).Anesthesia management under multi-mode monitoring was performed in the four groups,by BIS,TCI of propofol,low-tidal-volume lung protective ventilation management strategy,body temperature protection,and postoperative multimodal analgesia techniques basing on bilateral abdominal transversus abdominis plane block.The incidence of hypertension(or hypotension),myocardial infarction(myocardial ischemia)/angina,heart failure,arrhythmia,cerebral infarction/cerebral ischemic attack,renal failure,or other related complications were recorded during hospitalization.And complications in 30-days after surgery were recorded by telephone follow-up.Statistical analysis was performed by SPSS16.0 software package.And P<0.05 was considered statistically significant.Results Compared with group E,the crystal,colloid and total fluid infusion were reduced in group G and group D(P<0.05).The heart rates of group D and H were less than group E at T1~5,and group D was less than group G(P <0.05).Extubation time and PACU discharge of group G was shorter than group E,group D was shorter than group H(P<0.05).Compared with group E,extubation time,PACU discharge,and gastrointestinal defecation time were shorter in group D;the incidence of Severe arrhythmia,new onset atrial fibrillation,total complication in hospital and in 30-days after surgery were reduced in group D(P<0.05).The incidence of total complication in hospital and in 30-days after surgery of group G and group H were less than group E,and group D was less than group G(P<0.05).Conclusion Goal-directed haemodynamic management combined with dexmedetomidine can improve outcome of the elderly patients with fragile heart function undergoing abdominal surgery.