| Objective:The objective of this study was to investigate the application of SVV-guided fluid therapy in laparoscopic colorectal cancer surgery in elderly patients under combined anesthesia.We also evaluated the renal-protection of this protocol by analysis of Scr,BUN,NGAL and KIM-1,and provided reference basis and theoretical guidance for subsequent clinical practice.Methods:One hundred elderly patients who underwent laparoscopic colorectal cancer surgery under combined anesthesia from December 2021 to February 2023 in our hospital were selected and randomly divided into control group（group C,n=50）and SVV-directed fluid therapy group（group S,n=50）.Group C was infused according to the"4-2-1"rule,while Group S used a cardiac output monitoring to maintain SVV<13%and CI>2.5L/（min-m2）.The two groups were treated with the same anesthesia induction and maintenance regimen.Mean arterial pressure,heart rate and central venous pressure were recorded at the time of entry（T0）,5 minutes after establishing artificial pneumoperitoneum（T1）,5 minutes after Trendelenburg position（T2）,5minutes after stopping pneumoperitoneum（T3）and 5 minutes after recovery position（T4）.The preoperative,intraoperative and postoperative blood gas analysis values were monitored;Scr and BUN were monitored between the two groups before,1 d and 3 d postoperatively;Venous blood was collected and NGAL and KIM-1 were detected before（t0）,2 h（t1）and 24 h（t2）postoperatively by ELISA.Preoperative general information was collected;intraoperative fluid intake and output,use of the vasoactive drug norepinephrine was recorded;postoperative follow-up was performed to record the time of first defecation,bowel movement,feeding,down time,length of hospital stays,hospitalization cost and postoperative complications.All data were statistically analyzed using SPSS25.0 statistical software to compare the perioperative conditions and postoperative complications of the elderly patients in the two groups.Results:1.There were no significant differences in baseline data such as age,sex,height,weight,BMI,type Of surgery,ASA classification and comorbidities（P>0.05）.2.Compared with group C,group S had more crystalloid volume（P<0.05）and less norepinephrine use（P<0.05）.There was no statistically significant difference in other general intraoperative conditions between the two groups of patients（P>0.05）.3.MAP and HR in both groups were lower at the T1-T3 moment than at the T0 moment,and the values in group S were lower in the normal range.The values of CVP were significantly higher in both groups at the moment of T1-T3 with the establishment of pneumoperitoneum and the change of position compared to T0（P<0.05）.The c HCO3-and lactate（Lac）values in the blood gas analysis were more stable in group S compared with group C（P>0.05）;the total hemoglobin（t Hb）concentrations in both groups decreased gradually compared with the preoperative values（P<0.05）;the PH and BE values in both groups decreased compared with the preoperative values,and there was no statistical significance between the groups.All these results suggested that the internal environment of the body was"more acidic".4.Patients in group C had a higher incidence of postoperative AKI compared to group S（P<0.05）.There was no statistical significance in the recovery of gastrointestinal function and other complications between the two groups.In order to find highly sensitive and highly specific early biomarkers of AKI,patients in group C were divided into AKI group and NAKI group.The diagnostic efficacy of Scr,BUN,NGAL and KIM-1 was evaluated by ROC curve and area under the curve,of which Scr had the best diagnostic efficacy.Conclusion:1.SVV-guided fluid therapy increased intraoperative crystalloid volume,reduced use of the vasoactive drug norepinephrine,improved tissue perfusion and maintain hemodynamic stability2.SVV-guided fluid therapy can reduce the occurrence of AKI after radical colorectal cancer surgery in elderly patients without increasing hospitalization costs and should be promoted in clinical practice.SVV-guided fluid therapy can protect renal function.3.Serum creatinine has the best diagnostic efficacy in postoperative AKI.Novel kidney injury factors NGAL and KIM-1 have certain value in the early diagnosis of postoperative AKI.4.CVP changes greatly in elderly patients undergoing laparoscopic radical colorectal cancer surgery under the influence of CO2 pneumoperitoneum and body position,and cannot be used as an indicator to judge the volume status of the organism. |
