Effect Of Goal-directed Fluid Therapy On The Capacity Of Gastrointestinal Surgery In Elderly Patients With General Anesthesia Combined With Epidural Anesthesia

Objective To explore the effect of goal-directed fluid therapy on the capacity and hemodynamics and postoperative complications of gastrointestinal open surgery in elderly patients with general anesthesia combined with epidural anesthesia.Method Selection of 40 patients undergoing elective gastrointestinal open surgery period from August 2016 to June 2017 in this Hospital.The patients were randomly divided into two groups:group S(goal-directed fluid therapy group,n=20)and group C(conventional therapy group,n=20).Two groups of patients after radial artery puncture catheter under local anesthesia were respectively connected with Vigileo cardiac output monitor and FloTrac pressure transducer,continuous monitoring of cardiac output(CO),stroke volume(SV)and stroke volume variation(SVV).In the left lateral position for T10-T12 epidural puncture and confirm the effect of epidural.The two groups of patients with the same anesthesia induction,endotracheal intubation for right subclavian vein puncture or right internal jugular vein and central venous pressure(CVP)monitoring.Hemodynamic parameters and tissue perfusion were observed before induction of anesthesia(TO),after tracheal intubation(T1),initial operation(T2),10min after operation(T3),1h after operation(T4),and at the end of Operation(T5).and intraoperative fluid usage,operation time,exhaust time,ambulation time,postoperative complications and hospital stay were analyzed in two groups of patients.Results(1)Two groups of patients in the liquid intake,compared with Group C,the total amount of infusion in group S was significantly reduced(1687.50±194.58 vs 2102.50±249.99 ml),but the amount of colloid used increased(750.25±108.82 vs 512.50±89.26 ml),with statistical difference(P<0.05).(2)There was no significant difference between the average arterial pressure and the heart rate in the two groups,and the group S and Group C increased(102.75±6.99 vs 95.85±8.21 mmHg)when compared with T2,which was statistically significant.The cardiac output and stroke volume in group S were significantly increased compared with C group in T3 and T4,and the the stroke volume variability was decreased.(3)In terms of lactic acid,Group C had an elevated trend,the group S was significantly reduced,and there were significant statistical differences between the two groups(0.96±0.28 vs 1.28 ± 0.33)at T5(P<0.05).(4)In the postoperative complications of the two groups of patients,group S with early exhaust time(70.55±11.43 vs 87.85± 12.49 hours),and discharge time(10.70 ± 1.78 vs12.05 ± 2.04 days),The postoperative complications decreased.especially the incidence of hypotension was significantly reduced,with statistically significant differences(P<0.05).Conclusion Goal-directed fluid therapy plays an important guiding role in the acceptance of general anesthesia combined with epidural anesthesia in elderly patients in treatment capacity.The more stable hemodynamics during operation,reduce the postoperative complications,especially the incidence of hypotension was significantly lower.