The Application Of Goal-Directed Fluid Therapy Combined With Low-Dose Methoxamine In Combined Radical Thoracoabdominal Surgery For Esophageal Carcinoma

Objectives:Against the background of prophylactic intravenous injection of 1.0?2.5 ug·kg-1·min-1 low-dose methoxamine,to compare the effects of goal-directed fluid therapy(GDFT)and restrictive fluid therapy on hemodynamics,oxygenation and the occurrence of early postoperative complications during radical esophageal cancer surgery.Provide more optimized fluid management for patients with radical esophageal cancer in clinical practice to achieve rapid recovery.Methods:Thirty-six patients with planned thoracoabdominal laparoscopic radical incision esophageal cancer were selected from the Third Affiliated Hospital of Kunming Medical University.The patients from December 2018 to December 2019,age 45?66,weight 47?68 kg,body mass index(BMI)18.65?24.09 kg/m2,ASA class II,New York Heart Association NYHA score class I.Preoperative lung function test results are normal or only mild pulmonary ventilation disorder.No hypertension,diabetes,coronary heart disease,arrhythmia,respiratory diseases,central nervous system diseases and other metabolic diseases before surgery.No history of taking glucocorticoids and special drugs.Preoperative blood routine,urine routine,stool routine,myocardial enzymes,liver and kidney function,and coagulation function were not significantly abnormal.No significant change in recent weight of the patient before surgery.36 patients were divided into goal-directed fluid therapy group(GDFT group)and empirically restricted fluid therapy group(Control group)according to random number table method.Heart rate,blood pressure,and pulse oxygen saturation vital signs were monitored after the two gros of atients entered the of room.Right internal jugular vein puncture and catheterization under local anesthesia,and connection with the FloTrac/Vigileo system for stroke volume variability(SVV),cardiac output(CO),Monitoring of cardiac index(CI)and other indicators.After the control group is connected to FloTrac/Vigileo,the screen will be blocked,and the relevant monitoring indicators can only be recorded by the anesthesia nurse at regular intervals.Both groups of patients used the same anesthetic drugs.After anesthesia induction,a tracheal catheter was used to intubate the bronchial occluder.The bronchial occluder blocked the right main bronchus of the patient,and the electronic fiber bronchoscope was used to determine the correct occluder position.The two groups of patients underwent EEG bispectral index(BIS)monitoring during the entire operation,and the anesthetic drug dose was adjusted to maintain the anesthesia depth at the BIS value of 40?60.After the central venous access was opened in the two groups of patients,a small dose of prophylactic intravenous infusion of methoxamine was started 1 min before induction,and the pumping rate was 1.0?2.5ug·kg-1·min-1.The control group used an empirical solution to limit liquid therapy for liquid management:loss of fluid redistribution due to vasodilator effect without anesthesia and supplement to reduce fluid loss during thoracoabdominal surgery.Patients in the GDFT group were monitored by the FloTrac/Vigileo system,with a target SVV value of 8?10%and a CI>2.5L/min·m-2 for fluid management.Observed and recorded indicators are:before induction of anesthesia(T0),before surgical excision(T1),two-lungs ventilation(TLV)15min(T2),one-lung ventilation(OLV)15min(T3),two-lungs ventilation for 15min after lung expansion(T4),after surgery completion(T5),and HR,MAP,SVV,CO,CI,SV,and SVI of patients at each time point.Arterial blood samples were taken before and after operation and their PaO2,Lac,Glu,Hb,Hct values were determined.Infusion volume,crystal volume,colloid volume,urine volume,blood loss,and use of vasoactive drugs.Extubation time,hospitalization time,time to get out of bed,first anus exhaust time after anesthesia recovery room after surgery.Incidence of oxygenation indicators and related complications at three days after surgery.Results:30 patients(GDFT group n=15,Control group n=15)entered the final study and statistical analysis of data.1.General information before operationThere were no significant differences in age,sex ratio,weight,BMI,and ASA between the two groups of patients,and there was no statistical significance(P>0.05).2.Intraoperative general informationThere was no significant difference in anesthesia time,operation time,one-lung ventilation time,pneumoperitoneum time,and pneumoperitoneum pressure between the two groups of patients(P>0.05).3.Intraoperative hemodynamicsAt T4 and T5,the HR in the GDFT group was less than that in the Control group,and the difference was statistically significant(P<0.05).The MAP,SVV,CO,CI,SV,and SVI in the GDFT group were higher than those in the Control group,and the differences were statistically significant(P<0.05)4.Intraoperative results of other indicatorsIn terms of drug use,there was no significant difference in the use of vasoactive drugs between the two groups(P>0.05).In terms of blood gas analysis,there was no significant difference in lactic acid,blood glucose,hemoglobin,and hematocrit between the two groups of patients(P>0.05).Compared with T0,PaO2/FiO2 in the Control group decreased significantly at T5,the difference was statistically significant(P<0.05).In terms of liquid management,the total fluid volume of the GDFT group was less than that of the Control group,and the decrease in crystalline fluid was the most significant difference(P<0.05),while the colloidal fluid of the GDFT group was greater than the Control group,and the difference was statistically significant(P<0.05).The urine volume of patients in the control group was significantly higher than that in the GDFT group,and the difference was statistically significant(P<0.05).5.Postoperative indicatorsIn terms of postoperative recovery,the time to get out of bed and the time of the first anal exhaustion in the GDFT group were significantly earlier than those in the Control group,the difference was statistically significant(P<0.05).In terms of complications,the incidence of postoperative nausea,vomiting,cough,sputum,and pain complications in the GDFT group was significantly lower than that in the Control group,the difference was statistically significant(P<0.05).In terms of postoperative oxygenation,the difference in oxygenation index between the two groups of patients at 3 days after operation was statistically significant(P<0.05).The oxygenation of the GDFT group was better than that of the Control group.Conclusions:1.In the context of preventive intravenous pumping of low-dose methoxamine,both goal-directed fluid therapy and restrictive fluid therapy can better perform fluid management during radical esophageal cancer surgery.2.Compared with restrictive fluid therapy,goal-directed fluid therapy combined with low-dose methoxamine pump injection under less fluid infusion can obtain more stable hemodynamic parameters and better oxygenation indicators,which is beneficial to Improve perfusion of various organs and tissues of the body3.Compared with restrictive fluid therapy,goal-directed fluid therapy combined with low-dose methoxamine pump injection can accelerate the recovery of gastrointestinal function of patients,reduce the incidence of postoperative complications,and help patients recover soon.