Evaluation Of The Curative Effect Of Guiding Goal-directed Fluid Replacement With Inferior Vena Cava Ultrasound In Hip Replacement

Objective: To explore the effect of the therapy that goal-directed fluid replacement and standard fluid replacement was guided by using ultrasound to measure the diameter of inferior vena cava(IVC)on the patients receiving hip replacement.Methods: Clinical data of 80 patients who were scheduled to undergo hip replacement surgery at the Sixth Affiliated Hospital of Xinjiang Medical University from September 2018 to April 2019 were selected.They did not have the dysfunction of cardiopulmonary(ASA class: Class I-II).Among them there were 44 male patients and 36 female patients,with age between45 and 70.They were randomLy divided into two groups with the random number table:goal-directed fluid replacement(GFR)(group G,n = 40)and standard fluid replacement(SFR)(Group C,n = 40).Non-invasive blood pressure,pulse oxygenation index were monitored routinely in both groups after admission,and venous channels were opened after electrocardiogram.Patients in both groups all underwent combined spinal-epidural anesthesia.Subarachnoid space was given light specific gravity ropivacaine 10-13 mg.Maintain anesthesia plane at T8 below.The inferior vena cava diameter(IVCD)and the inferior vena cava collapse index(IVC-CI)were measured at the time of T0-T4(T0patients lied on their back for 5 minutes,and T1 patients received fluid replacement 10 before operation).IVCmax was the maximum diameter,and IVCmin was the minimum diameter.In case of ICV-CI ≥40%,fluid therapy was given.In case of ICV-CI(27)40%,the fluid replacement speed and volume were controlled.When the ICV-CI was less than 30%,the fluid replacement speed and volume were reduced.When the ICV-CI is less than 20%,the fluid replacement speed and volume were strictly controlled.The patients in Group C was given 8mL/kg ringer lactate solution to supplement compensatory intravascular volume expansion before anesthesia.During the operation,the amount required by physiological requirement,cumulative losses,the third space losses and ongoing losses were supplemented.For patients in both groups,when the mean arterial pressure(MAP)was 30% lower than that of MAP before operation,6mg ephedrine was given.When hemoglobin was lower than 80g/L,infusion of suspended red blood cells was performed.Results: There were statistically significant differences in venous oxygen saturation(ScvO2),heart rate,incidence of intraoperative hemodynamic adverse events and total urine volume(P < 0.05)in different time period after treatment of patients in two groups.Conclusion: The program for guiding the perioperative goal-directed fluid replacement with the data of the inferior vena cava measured by ultrasound is a good fluid management program for patients undergoing hip replacement.This program can achieve the hemodynamic stability of the perioperative patients,reduce the incidence of perioperative hypotension and facilitate the recovery of patients.