The Application Of Intraoperative Goal-directed Fluid Therapy In Lobectomy

ObjectiveAs an important part of enhanced recovery after surgery,fluid management is one of the key concerns of anesthesiologists.Excessive or insufficient fluid infusion will increase the incidence of postoperative complications,affecting the prognosis of patients.Goal-directed fluid therapy?GDFT?is a method of maintaining normal or abnormal hemodynamic parameters through individualized fluid replacement,to ensure the circulating blood volume within a suitable range.Most of clinical studies on GDFT focused on abdominal surgery,while few studies involoved thoracic surgery.In particular,there is no study on the impact of GDFT in lobectomy on postoperative outcome compared with restrictive fluid therapy.Therefore,meta-analysis was firstly used to evaluate whether intraoperative GDFT can reduce postoperative complications in patients undergoing elective abdominal surgery compared with other fluid therapies,so as to provide better clinical evidence for GDFT in elective abdominal surgery.Then,we adopted ODM-directed fluid therapy or restrictive fluid therapy in patients undergoing elective lobectomy to explore whether GDFT can improve postoperative outcome in lobectomy.MethodsThis study firstly used the meta-analysis approach and followed the PRISMA guidelines.References from 1980 to August 2017 in Medline,CENTRAL,EMBASE,Web of Science,Wan Fang,CNKI databases were searched.GDFT as therapy group,and other fluid therapy as control group.The outcome indicators included the postoperative morbidity,mortality,length of hospital stay,length of ICU stay.Meta-analysis was performed using RevMan 5.3.Then,sixty patients in elective lobectomy were randomly divided into goal-directed fluid therapy group?G group?or restrictive fluid therapy group?R group?.The two groups were managed according to their respective rehydration protocol.Record MAP,HR,SpO₂,FTc,SV,CI and the amount of fluid during the surgery.According to POMS,postoperative morbidity on the 1st,3rd,5th and 8th days were evaluated.The length of hospital stay,the reason and time of ICU admission,the reason and time of hospital death were also recorded.Statistical analysis was performed using SPSS 22.0.ResultsTwenty-nine randomized controlled trials were included involving 1543 patients in GDFT and 1475 patients in control group.The results of meta-analysis showed that compared with control group,patients in the GDFT group had lower postoperative morbidity and shorter length of hospital stay?P<0.05?.However,There were no significant differences in the mortality and length of ICU stay between the two groups?P>0.05?.When patients managed in an ERAS setting or control group as restrictive fluid therapy,no differences were seen in postoperative morbidity,mortality and length of hospital stay between the two groups?P>0.05?.A total of 54 patients were included in the final analysis?GDFT group 27,control group 27?.There were no significant differences in general information?P>0.05?.Compared with group R,group G received more intraoperative colloids and less norepinephrine,with statistically significant differences?P<0.05?.There were no significant differences in postoperative morbidity and the length of hospital stay between two groups?P>0.05?.No one entered the ICU after surgery,and no death occurred in the hospital.Conclusions1.Intraoperative GDFT in elective abdominal surgery can reduce postoperative morbidity and the length of hospital stay,but not reduce mortality and length of ICU stay.2.When patients managed in an ERAS setting or control group as restrictive fluid therapy,GDFT can not reduce postoperative morbidity,mortality and length of hospital stay.3.Compared with restrictive fluid therapy,GDFT can not reduce postoperative morbidity and length of hospital stay during lobectomy,but can improve intraoperative tissue perfusion.