Influence Of Goal-directed Fluid Therapy On Serum Lactic Acid And Postoperative Delirium In Elderly Hypertension Patients Undergoing Controlled Hypotension Nasal Endoscopic Surgery

Objective:The purpose of this study was to explore the effect of goal-directed fluid therapy on postoperative delirium of patients with hypertension.Method:A total of 60 elderly patients with primary hypertension undergoing elective line of nasal endoscopic surgery(age > 65 years)was selected,randomly divided into two groups,conventional infusion group(group C,n = 30)and goal-directed liquid treatment group(group G,n = 30).Group C was treated with conventional fluid in miller’s anesthesia.Group G using intraoperative GDFT,under the Flo Trac/Vigileo system monitoring maintain variation degree of stroke(stroke volume variation,SVV)from 8% to 13%,the measurements of two groups of patients with preoperative 5 min(T0),the operation started(T1),the operation started 1 h(T2),surgery(T3)towards the end of hemodynamic and tissue perfusion index,records of intake and vascular active drug usage,within three days after the occurrence of delirium and postoperative complications.Results:There was no significant difference in intraoperative infusion volume between the two groups(G group 1245 ±101.24 ml vs C group 1315 ± 91.44ml),but the amount of colloid infusion in G group was higher(550 ± 115.47 ml vs470±58.69 ml,P<0.05).The hemodynamics was more stable(MAP of T2:G group 72.60±2.22 mm Hg vs C group 69.90±2.02 mm Hg,P<0.05;MAP of T3:G group 74.30±3.23 mm Hg vs C group 70.20±2.39 mm Hg,P<0.05),the tissue perfusion was better(Serum lactic acid of T2:G group 2.49±0.14mmol/L vs C group 2.98±0.29mmol/L,P<0.05;Serum lactic acid of T3:G group 2.64±0.19mmol/L vs C group 3.51±0.20mmol/L,P<0.05),and the incidence of hypotension was lower(G group 10% vs C group 50%,P<0.05).Although there was no significant difference in postoperative delirium incidence between the two groups,there was no significant difference in the complications of nausea and vomiting,fever and cough,but the incidence of postoperative complications in G group was lower than that in group C.Conclusion:GDFT has no effect on the incidence of postoperative delirium in nasal endoscopic surgery for elderly patients with hypertensive,but can reduce intraoperative serum lactic acid,improve microcirculation,maintain intraoperative hemodynamic stability,ensure the perfusion of vital organ.