The Clinical Application Of Internal Jugular Vein Respiratory Variability In Guiding Goal-directed Fluid Therapy In Gastrointestinal Surgery In The Elderly

Objective:This study aims to observe the effect of goal-directed fluid therapy guided by respiratory variability of internal jugular vein in gastrointestinal surgery for elderly patients.Methods: 60 elderly patients were randomly divided into two groups with 30 in each group.Group C: the total volume of infusion includes compensatory volume expansion,cumulative loss,physiological demand,continuous loss and third space transfer.Before induction of general anesthesia,8ml/kg of 6% hydroxyethyl starch(HES)130/0.4 solution was infused to supplement compensatory capacity expansion;during operation,the same volume of 6% HES(130/0.4)solution was infused intravenously according to the volume of blood loss;according to the 4-2-1 rule,Ringer’s lactate solution was infused intravenously to supplement cumulative loss(1/3 of the total amount per hour for an three-hour operation)and physiological demand;the third space transfer volume was Ringer’s lactate solution 5ml/kg.During induction and operation,MAP≥65 mm Hg,CVP 8 ~ 10 cm H2O were maintained.If MAP < 65 mm Hg,noradrenaline was injected intravenously for 10 ug each time,and repeated if necessary.Group G: before anesthesia induction,Ringer’s lactate solution was used to supplement the cumulative loss,and then it was used to supplement the physiological demand per hour.After induction of general anesthesia,VIJV in right internal jugular vein was measured by ultrasound.If VIJV ≥ 20%,200 ml of 6% HES(130/0.4)solution was infused with in 15 min,and repeated if necessary until VIJV< 20%.During the operation,VIJV was measured every 30 minutes.The change of CVP was monitored to ensure that the upper limit of CVP does not exceed 10 cm H2O.MAP≥65mm Hg was maintained during induction and operation.If MAP < 65 mm Hg,noradrenaline was injected intravenously for 10 ug each time.If the urine volume was less than 1 ml/kg.h,200 ml of Ringer’s lactate solution was infused rapidly within 15 minutes.During the operation,we monitor and record the volume of total fluid,crystal volume,colloid volume,intraoperative bleeding volume,urine volume and CVP;we also observe the average airway pressure;we record the operation time and the times of norepinephrine use as well.We record arterial lactate levels before anesthesia induction,immediately after operation,the first day after operation and the second day after operation;we also record the first exhaust time and hospitalization time after operation as well as the 24-hour postoperative cardiovascular events,pulmonary complications and incision infection.Results: Compared with group C,the total infusion volume and crystal fluid input volume in group G were significantly reduced,while the colloid fluid input volume was significantly increased(P< 0.05);the total urine volume in group G was less than that in group C,with a statistically significant difference(P<0.05);the number of times of noradrenaline use in group G was significantly less than that in group C(P<0.05);for patients in group C,the arterial blood lactate concentration was significantly higher immediately after the operation,on the first day after the operation,on the second day after operation th an that before anesthesia induction(P<0.05);for patients in group G,the arterial blood lactate concentration after operation was significantly higher than that before anesthesia induction(P< 0.05),but the values were in the normal range.Compared with group C,the lactate concentration of arterial blood in group G was significantly lower than that in group C at all time points after operation(P< 0.05).Compared with group C,the first postoperative exhaust time of group G was significantly shorter(P< 0.05);the incidence of cardiovascular adverse events(mainly hypertension,hypotension,arrhythmia),the incidence of pulmonary complications(mainly cough and phlegm)and the average hospitalization time of group G were significantly lower than that of group C(P< 0.05)).The incidence of nausea and vomiting in group G was significantly lower than that in group C(P< 0.05).There were no complications such as incision infection and anastomotic leakage in both groups.Conclusion: Internal jugular vein respiratory variability(VIJV)can be used as a goal-directed fluid therapy in gastrointestinal surgery in the elderly.It reduces the total fluid infusion during operation without affecting tissue perfusion,cardiovascular adverse events,pulmonary complications and postoperative nausea and vomiting 24 hours after operation,and shortens the hospitalization time of patients.It also provides reference for clinical selection of non-invasive monitoring target to guide patients’ intraoperative fluid management.