| Objective To compare the effects of conventional fluid replacement and PPV-oriented GDFT combined with norepinephrine on intraoperative tissue oxygen metabolism in elderly patients with unilateral hip and knee arthroplasty,so as to provide reference for intraoperative fluid management in elderly patients with joint arthroplasty.Methods Choose in October 2020 to March 2021 marked line in the first affiliated hospital of Chongqing medical university single hip or knee replacement in elderly patients with a total of 40 cases（including 9 cases of men,31 cases women）aged 60 or higher,BMI18～26,ASAⅡ-Ⅲ。They were divided into two groups according to the random number scale.GDFT combined with norepinephrine group（G group）and conventional infusion group（C group）,with 20 patients in each group.Patients in group C and group G were forbidden from drinking and fasting according to ERAS standard before surgery,and were given carbohydrate energy agent orally two hours before surgery.Group C received routine infusion program after admission,that is,supplemental physiological requirements,fasting and drinking abstention,anaesthetic volume expansion,additional loss and blood loss.Blood loss was supplemented with the same amount of hydroxyethyl starch 130/0.4 sodium chloride injection（Voluven）was added for blood loss.Group G received PPV from the entry to the completion of the whole operation to instruct GDFT to perform colloidal fluid shock to maximize PPV.In other words,after the patient entered the room,lactate Ringer’s solution was continuously injected at a rate of5ml/kg per hour to establish PPV monitoring for the invasive artery.If PPV rapidly increased≥13%,it indicated that the preload was too low.200ml of voluven was administered within 5-10 minutes for impact,and then PPV was evaluated.If PPV is still greater than 13%and is maintained over 1min,then fast input voluven until PPV control is achieved within 13%.Group C and group G were treated with conventional anesthesia induction using the same method and drugs.Group G was immediately pumped with norepinephrine 0.01～0.1ug/（kg·min）after anesthesia induction.The blood pressure of group C and G was maintained within the range of±20%of the original basal blood pressure.If MAP<65mm Hg,ephedrine 6mg or norepinephrine 50ug were injected intravenantly.Urine volume,blood loss,crystal and colloidal infusion volume,operative time,times of intravenous hypertensive drug injection,and blood pressure,heart rate and mean arterial pressure at each time point before anesthesia induction（T0）,before surgery（T1）,30min after surgery（T2）,and at the end of surgery（T3）were recorded.Radial artery and internal carotid venous blood were collected at each time point for blood gas analysis.Pa O2,Sa O2,Scv O2,Lac and Hb were recorded ERO2and Da-cv O2were calculated to compare the differences between the three groups.Results There were no statistically significant differences in intraoperative blood pressure,heart rate,total infusion volume and urine volume between group C and G（P>0.05）.The amount of colloids input in group G was significantly higher than that in group C,and the times of intravenous infusion of antihypertensive drugs were significantly lower than that in group C（P<0.05）.The ERO2and Da-cv O2content in group G were lower than that in group C（P<0.05）.Conclusion For elderly patients with unilateral hip or knee arthroplasty,intraoperative GDFT guided by PPV combined with norepinephrine liquid therapy compared with conventional infusion method can provide patients with more stable intraoperative circulation,better maintenance of tissue perfusion and improvement of tissue oxygen metabolism. |
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