Goal-directed fluid therapy optimizes hemodynamics on the elderly patients undergoing lumbar decompressive surgery and reduces postoperative complications

Abstract

Abstract: Objective To explore the impact of goal-directed fluid therapy(GDT) management strategy on the perioperative complications of elderly patients undergoing lumbar spine surgery. Methods Elderly patients undergoing elective lumbar spine surgery were selected and randomly divided into the control group with routine fluid management according to the existing anesthetic fluid treatment standards and the experimental group for intraoperative fluid management using GDT strategies. Hemodynamic indicators, perioperative fluid, gastrointestinal function indicators and the incidence of complications in the 30 days after surgery were collected. Results Cardiac output (CO) and cardiac index (CI) of the experimental group were significantly higher than those of the control group (P＜0.05) at the end of operation. The two groups also showed a significant different(P＜0.05) in total intraoperative fluid infusion volume, which was more significant than comoparison with experimental(GDT)group. However,the dosage of vasoactive drugs was significantly lower in the observation group (P＜0.05). Compared with the observation group, the number of patients receiving medicine-assisted defecation and exhaust was significantly less than that in the experimental group (P＜0.05). Compared with the observation group, the experimental group has significantly less was complication infectio (P＜0.05). Conclusions GDT can reduce postoperative complications in elderly patients undergoing lumbar spine surgery, thereby improving the perfusion and prognosis.

Key words: goal-directed fluid therapy, lactate acid, perfusion, infection

CLC Number:

R614.2

XIA Di, XU Li, LI Xu, HUANG Yu-guang. Goal-directed fluid therapy optimizes hemodynamics on the elderly patients undergoing lumbar decompressive surgery and reduces postoperative complications[J]. Basic & Clinical Medicine, 2021, 41(2): 178-183.

References

[1] Zaina F, Tomkins-Lane C, Carragee E, et al. Surgical versus non-surgical treatment for lumbar spinal stenosis[J]. Cochrane Database Syst Rev, 2016.doi:10.1002/14651858.CD010264.
[2] Deyo RA, Mirza SK, Martin BI, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults[J]. JAMA, 2010, 303:1259-1265.
[3] Yoshihara H, Yoneoka D. Trends in the utilization of blood transfusions in spinal fusion in the United States from 2000 to 2009[J]. Spine (Phila Pa 1976), 2014, 39:297-303.
[4] Kong TK. Aging China: the demographic challenge to China's economic prospects[J]. Choice: Current Reviews for Academic Libraries, 2005, 43:151.
[5] Benes J, Chytra I, Altmann P, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study[J]. Crit Care, 2010, 14:R118.
[6] Deng QW, Tan WC, Zhao BC, et al. Is goal-directed fluid therapy based on dynamic variables alone sufficient to improve clinical outcomes among patients undergoing surgery? A meta-analysis[J]. Crit Care, 2018, 22:298.
[7] Hamilton-Davies C, Mythen Mg, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry[J]. Intensive Care Med, 1997, 23:276-281.
[8] Ince C. The microcirculation is the motor of sepsis[J]. Crit Care, 2005, 9 Suppl 4:S13-19.
[9] Sujatha PP, Nileshwar A, Krishna HM, et al. Goal-directed vs traditional approach to intraoperative fluid therapy during open major bowel surgery: Is there a difference?[J] Anesthesiol Res Pract, 2019. doi:10.1155/2019/3408940.
[10] Hamed MA, Goda AS, Eldein RMS. Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and autocalibrated arterial pressure waveform analysis vigileo-flotrac system in on-pump coronary artery bypass graft surgery: a randomized controlled studya[J]. Anesth Essays Res, 2018, 12:517-521.
[11] Sulzer JK, Sastry AV, Meyer LM, et al. The impact of intraoperative goal-directed fluid therapy on complications after pancreaticoduodenectomy[J]. Ann Med Surg (Lond), 2018, 36:23-28.
[12] Russo A, Aceto P, Grieco DL, et al. Goal-directed hemodynamic management in patients undergoing primary debulking gynaecological surgery: a matched-controlled precision medicine study[J]. Gynecol Oncol, 2018, 151:299-305.
[13] Feng S, Yang S, Xiao W, et al. Effects of perioperative goal-directed fluid therapy combined with the application of alpha-1 adrenergic agonists on postoperative outcomes: a systematic review and meta-analysis[J]. BMC Anesthesiol, 2018.doi:10.1186/s12871-018-0564-y.
[14] Reisinger KW, Willigers HM, Jansen J, et al. Doppler-guided goal-directed fluid therapy does not affect intestinal cell damage but increases global gastrointestinal perfusion in colorectal surgery: a randomized controlled trial[J]. Colorectal Dis, 2017, 19:1081-1091.
[15] Zhang X, Zheng W, Chen C, et al. Goal-directed fluid therapy does not reduce postoperative ileus in gastrointestinal surgery: a meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2018.doi:10.1097/MD.0000000000013097.