Effect of goal-directed fluid therapy guided by different goals on endothelial glycocalyx in patients undergoing high-risk abdominal surgery: a prospective randomized controlled clinical study

Abstract

Objective To evaluate the effect of goal-directed fluid therapy (GDFT) guided by different goals on endothelial glycocalyx, inflammatory cytokines and postoperative complications in patients undergoing high-risk abdominal surgery. Methods Eighty patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m2, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective retroperitoneal tumor resection, were divided into 2 groups (n=40 each) by a random number table method: stroke volume variation (SVV) 9%-14% group (L group, n=40) and SVV<9% group (H group, n=40). SVV 9%-14% and SVV<9% were used as the target and GDFT was performed though combing with cardiac index and mean arterial pressure.The concentrations of syndecan 1, hyaluronic acid, heparan sulfate, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in serum were determined at 5 min before skin incision (T0), 1 h after skin incision (T1), 4 h after skin incision (T2) and 24 and 72 h after operation (T3, 4). The intraoperative urine volume, blood loss, volume of liquid infused, volume of blood infused, amount of norepinephrine consumed, operation time, extubation time and length of postoperative hospital stay were recorded. Results Compared with the baseline value at T0, the concentrations of syndecan 1, hyaluronic acid, heparan sulfate, TNF-α and IL-6 in serum were significantly increased at T1-4 in H group, and the concentrations of syndecan 1, heparan sulfate, TNF-α and IL-6 in serum at T1-4 and concentrations of hyaluronic acid at T1-3 were significantly increased in L group (P<0.05). Compared with H group, the volume of liquid infused was significantly reduced, the amount of norepinephrine consumed was increased, the concentrations of syndecan 1, IL-6 and TNF-α in serum were decreased at T1-4, the concentrations of hyaluronic acid were decreased at T2, 3, and the concentrations of heparan sulfate were decreased at T1-3 in group L (P<0.05). Conclusion Compared with GDFT with the target of SVV<9%, GDFT with the target of SVV 9%-14% is more helpful in decreasing degradation of endothelial glycocalyx during the perioperative period and in reducing damage to endothelial barrier, and the mechanism may be related to inhibiting inflammatory responses of patients undergoing high-risk abdominal surgery. Key words: Fluid Therapy; Glycocalyx