Effects Of Svv-based Goal-directed Fluid Therapy On The Prognosis Of Patients Undergoing Open Abdominal Tumor Surgery

Objective:Abdominal tumor open surgery is traumatic,long-lasting,has many bleeding opportunities,and has a high risk of surgery.Perioperative anesthesia management is essential,and fluid therapy is one of them.Liquid therapy has been a hot topic for the perfusion of important organs during the perioperative period,reducing postoperative complications,and shortening the length of hospital stay.Goal-directed fluid therapy（GDFT）is based on hemodynamic parameters,tissue perfusion indicators,and the patient’s judgment of fluid requirements.It guides the application of intraoperative fluid input and vasoactive drugs to improve organ perfusion and tissue oxygenation.Liquid therapy is individualized.This study was to investigate the effects of fluid therapy strategies on clinical outcomes such as hemodynamics,tissue perfusion,early postoperative recovery,and complication rates during anesthesia.Methods:A prospective case-control study was conducted to select 60 patients with open surgery for elective abdominal tumors from October 2017 to October 2018.The subjects were ASA II-III,aged 50-75 years,and were divided into two groups using computer randomization software group,group G（study group:target-directed fluid therapy group）and group C（control group:conventional fluid therapy group）,30 patients in each group.After the patient entered the room,the patient was safely checked for routine monitoring.The local anesthesia was placed under the radial artery catheterization and connected to the FloTrac/Vigileo monitoring system.The research team under the FloTrac/Vigileo monitoring,targeting the stroke variability（SVV）and cardiac index（CI）.According to the GDFT program（liquid impact method and liquid reaction method）capacity management;the control group under the basic life monitoring,using the conventional fluid replacement program:total liquid input=physiological demand+cumulative missing amount+continued loss+third gap loss Volume,combined with the experience of an anesthesiologist for intraoperative fluid management.Postoperative hospital stay and complications were the primary outcome measures;SVV,blood lactate（Lac）,blood glucose（Glu）,and gastrointestinal function recovery were used as secondary outcome measures.Mean arterial pressure（MAP）was collected at five time points before induction of anesthesia（T0）,immediately after induction of anesthesia（T1）,1 hour（T2）,3 hours（T3）,and（T4）.Central venous pressure（CVP）,heart rate（HR）,CI and SVV data;record the operation time,the total amount of fluid input during surgery,the amount of crystal glue,the amount of bleeding,the amount of blood transfusion,the amount of urine and the use of vasoactive drugs;Lac at T1,T3,T4,central venous oxygen saturation(ScvO₂),central venous-arterial carbon dioxide partial pressure difference（P（cv-a）CO₂）,oxygen supply index（DO₂I）,oxygen consumption index（VO₂I）Oxygen uptake rate（O₂ER）.The patient’s postoperative recovery was recorded:post-anesthesia monitoring treatment room（PACU）stay,extubation time,anesthesia recovery score（Steward）when leaving PACU,pain-related visual analogue scale（VAS）,bispectral index（BIS）,blood glucose（Glu）value;in the surgical ward:postoperative nausea,vomiting（PONV）incidence,first exhaust,eating,downtime activities;VAS value on the third day after surgery,Glu value;acute kidney within one week after surgery Injury,surgical incision infection,intestinal fistula,hospitalization time,and cost.Results:1.Preoperative general data of two groups of patients:60 patients with open surgery of abdominal tumor were selected according to the inclusion and exclusion criteria.There was no significant difference in preoperative data between the two groups（P>0.05）.2.Intraoperative data monitoring:Compared with group C,CVP and CI were significantly increased in group G-T3（P<0.05）,and SVV was significantly decreased in T1-T4 group（P<0.05）.There was no significant difference in MAP between the two groups（P>0.05）.The total infusion volume and crystalloid use in group G were significantly decreased,and the use of colloid and vasoactive drugs was significantly increased（P<0.05）.In group T3 and T4,group ScvO₂,DO₂I,VO₂I,O₂ER increased significantly,and was higher than that of group C（P<0.05）.Lac and P（cv-a）CO₂ decreased significantly,lower than group C（P<0.05）.Group C showed significant increase of Lac and ScvO₂ at T3 and T4.High,DO₂I increased significantly at T4,VO₂I,O₂ER decreased significantly（P<0.05）;3.Postoperative situation:The retention and extubation time of PACU in group G was significantly shorter than that in group C.The Steward score and BIS value were significantly higher than those in group C（P<0.05）.The incidence of PONV in group G was significantly lower than that in group C.The time of first exhaust,eating and going to the ground was significantly shorter than that of group C（P<0.05）.The incidence of surgical site infection was significantly lower in group G than in group C.The postoperative hospital stay was significantly shorter than that in group C（P<0.05）.There was one case of acute kidney injury and intestinal fistula in group C,and no group G occurred.Glu value in group G was significantly lower in group G than in group C（P<0.05）.The VAS value in the third day after operation was significantly lower in group G than in group C（P<0.05）.Conclusion:1.Goal-directed fluid therapy strategy based on SVV is conducive to smooth hemodynamics,improved tissue perfusion,reduced stress response,and protection of organ function;2.Goal-directed fluid therapy strategy is beneficial to the recovery of postoperative gastrointestinal function in surgical patients,reducing the incidence of postoperative complications and shortening the length of hospital stay;3.Hypotension during induction of anesthesia is associated with relative and absolute lack of blood volume.