Effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing resection of gastrointestinal tumor

Abstract

Objective To investigate the effect of goal-directed fluid therapy on postoperative rehabilitation in elderly patients undergoing resection of gastrointestinal tumor. Methods A total of 100 elderly patients of both sexes, aged 65-90 yr, of ASA physical status Ⅱ or Ⅲ, scheduled for elective radical operations for stomach, colon or rectal cancers, were included and randomly divided into 2 groups (n=50 each) using a random number table: goal-directed fluid therapy group (group G) and conventional fluid therapy group (group C). HR, mean arterial pressure, central venous pressure, arterial oxygen saturation and partial pressure of end-tidal CO2 were monitored continuously in the two groups.The FloTrac/Vigileo system was used to monitor cardiac output, cardiac index, stroke volume, stroke volume index and stroke volume variation at the same time in group G. In group C, mean arterial pressure was maintained at 60-110 mmHg, and central venous pressure at 6-12 cmH2O.In group G, cardiac index was maintained at 2.5-4.0 L·min-1·m-2, stroke volume variation at 2%-13%, mean arterial pressure at 65-110 mmHg and stroke volume index at 35-47 ml/m2.Crystalloid solution was compound electrolyte solution, and colloid solution was hydroxyethyl starch 130/0.4.The requirement for crystalloid and colloid, total volume of fluid infused, urine volume, and requirement for vasoactive agents were recorded during operation.The time for removal of the endotracheal tube, time when the patients passed the flatus, length of hospital stay after operation, total length of hospital stay, and total medical costs were recorded.The operation-related complications after operation, and development of cadiovascular and pulmonary complications, oliguria, anuria and renal insufficiency during and after operation were recorded. Results Compared with group C, the requirement for crystalloid and colloid, total volume of fluid infused and urine volume were significantly decreased, the requirement for vasoactive agents was increased, the length of hospital stay after operation, total length of hospital stay and time when the patients passed the flatus were shortened, and total medical costs were reduced, and the incidence of operation-related complications after operation, and cadiovascular and pulmonary complications was decreased in group G. Conclusion Goal-directed fluid therapy based on FloTrac/Vigileo system can significantly promote postoperative rehabilitation and shows certain clinical value in elderly patients undergoing resection of gastrointestinal tumor. Key words: Fluid therapy; Aged; Gastrointestinal neoplasms