Application Of Goal-Directed Fluid Therapy On Elderly Patients With Gastrointestinal Tumor

Objective:To observe the effect of Scvo₂guided fluid therapy?P?cv-a?CO₂ combined to ScvO₂ guided fluid therapy?SVV guided fluid therapy on blood gas?LPS?PCT and gastrointestinal function in patients undergoing resection of gastrointestinal tumor,and the feasibilty of application of goal-directed fluid therapy in this operations.Methods:Ninety patients of aged 60-85yr from Jan Twenty Sixteen to Feb Twenty Seventeen,ASA II or III,scheduled for elective redical operations for gastrointestinal cancers firstly,were included and randomly divided into three groups?n=30 each?using a random number table:Scvo₂ guided fluid therapy?group C?,P?cv-a?CO₂ combined to ScvO₂ guided fluid therapy?group S?,SVV guided fluid therapy?group G?.MAP?HR?CVP of patients were recorded at the same time before anesthesia?T₀??tumor removal?T₁??ending of surgery?T₂?respectively.PH?BE?HCO₃^-?Lac of venous blood samples and artery blood samples at the time T₀-T₂,6 hours after surgery?T₃?were recorded.Venous blood samples were collected at the time points of T₀ and T₃ to detect LPS?PCT.Crystalloid requirements?colloid requirements?total volume?bleeding volume?urine volume?peritoneal fluid volume?the use of vasoactive drugs were recorded.The time when the patients first exhausted and feeded after operation,length of hospital stay after operation also were recorded.Results:There was no satistical difference in basic demographic parameters of three groups.The changes of MAP?HR?CVP were all within normal range,cvp at T₂ was higher than T₀ in group C,and there was no statistical difference between the rest groups.The trend of PH and HCO₃^-of artery blood were similar in three groups,there were no statistical differences except the PH at T₁ in group S,but there was a decrease in the rest groups;compared withT₀,PH at T₁-T₃ of venous blood was decreased in three groups,HCO₃^-at T₂ and T₃ was decreased in three groups.Compared with group C,BE of artery blood was obviously increased at the time points of T₂ and T₃ in group S and G?the Lac of artery was obviously decreased in group S and G.Compared with group C,lac of venous blood was obviously decreased at T₃ in group S and G.Compared with group C,the requirement of colloid and the use of vasoconstrictors were increased in group S and G,the requirement of crystalloid?total volume of fluid infused and urine volume were decreased in group S and G.compared with group C,LPS and PCT were lower at the time points of T₃ in group S and G.Compared with group C,the time exhaust and feed,length of hospital was shortened in group S and G.Conclusion:?1?Compared with ScvO₂guided fluid therapy,P?cv-a?CO₂ combined to ScvO₂ and SVV guided fluid therapy could reduce lac,improve the microcirulatory perfusion,promote the recovery of gastrointestinal function and decrease the length of hopital after operations.?2?GDFT by P?cv-a?CO₂ combined to ScvO₂ can be used in elderly patients undergoing gastrointestinal tumor resection,it also has same clinical significance with GDFT by SVV.