Effect of goal-directed fluid therapy on postoperative intestinal function recovery in the aged patients with rectal cancer

Abstract

Objective To investigate the effect of intraoperative routine fluid therapy and goal-directed fluid therapy(GDFT) by FloTrac/Vigileo monitoring system on the recovery of intestinal function in aged patients with rectal cancer. Methods Sixty ASAⅠ~Ⅲ patients undergoing laparoscopic anterior resection of rectal cancer(Dixon operation), who were treated in the Third People's Hospital of Datong from August 2018 to May 2019 were selected and randomly divided into two groups according to the digital table, with 30 cases in each group.Group C received routine intraoperative fluid administration, and the total rate of fluid=deficit+ maintenance administration+ loss+ third space losses.Group G fluid therapy goal: cardiac index (CI) 2.5~4.0 L·min-1·(m2)-1, stroke volume variability (SVV) 13%, rapidly infused sodium lactate Ringer's injection 3 mL/kg(within 10 min via an infusion pump); if CI<2.5 L·min-1·(m2)-1, SVV<13%, infused dobutamine; if MAP<65 mmHg, CI≥2.5 L·min-1·(m2)-1, infused norepinephrine.Two groups were continously infused sodium lactate Ringer's injection 3 mL·kg-1·h-1.Equivalent volume 6% hetastarch was infused to supplement the blood loss.During the operation, Hb<80 g/L and red blood cells were transfused when bleeding continued.The total fluid intake, bleeding volume, urine volume, postoperative hospital stay days, postoperative intestinal function recovery(postoperative flatus time and eating time), the incidence of postoperative intestinal complications(postoperative inflammatory bowel obstruction, anastomotic leakage and anastomotic bleeding) were recorded.Intestinal fatty aid binding protein (iFABP) was measured at T0(before the induction), T1(at the end of surgery), T2(2 h after surgery), T3(24 h after surgery) by using ELISA kits. Results The intraoperative fluid intake was (2 051±466)mL in group C, and (1 811±413)mL in group G, there was statistically significant difference between the two groups(t=2.111, P=0.039). The postoperative exhaust time and hospitalization days in group G were 28.6(23.3, 32.1)h and 10.2(9.9, 12.1)d, respecticely, which were shorter than those in group C [32.6(27.1, 40.9)h and 11.6(10.7, 12.2)d] (Z=2.321, P=0.020, Z=2.435, P=0.015). The incidence of postoperative complications was 13%(4/30) in group C, and 10%(3/30) in group G, there was no statistically significant difference(P>0.05). The iFABP of group C at T1 and T2 after operation was significantly higher than those of group G(t=2.445, 3.098, P=0.018, 0.003). Conclusion GDFT can reduce intraoperative crystalloid infusion, promote early intestinal function recovery in elderly patients with rectal cancer, and reduce perioperative intestinal mucosal ischemic injury. Key words: Rectal neoplasms; Fluid therapy; Cardiac index; Stroke volume; Intestinal fatty aid binding protein; Intestinal mucosal; Postoperative complications; Aged