The evaluation of individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery

Abstract

Objective To evaluate the individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.Methods From January 2009 to December 2012,80 cases of coronary heart disease patients (aged 65-80 years) undergoing gastrointestinal surgery were divided into test group and control group by random digits table with 40 cases each.Traditional fluid therapy was used in control group in the intraoperative and postoperative period.Individualized fluid therapy was used in test group in the intraoperative and postoperative transferred to the intensive care unit (ICU) during the period of 24 h:in cardiac index (CI),stroke output index,stroke variation degree,under the guidance of indicators such as capacity titration type treatment.Hemodynamic index,fluid intake,incidence of cardiac adverse events and recovery of gastrointestinal function were compared in two groups into the operating room (T1),after anesthesia induction (T2),the operation started (T3),intraoperative 1 h (T4),the end of surgery (T5),transferred to the ICU 6 h (T6),transferred to the ICU 12 h (T7) and transferred to the ICU 24 h (T8).Results Compared with T1,two groups of patients with mean arterial pressure (MAP),central venous pressure (CVP),CI and stroke volume (SV) were lower than those at T2 [test group:(68.1 ±6.1) mm Hg(1 mm Hg =0.133 kPa) vs.(84.4 ±5.2) mm Hg,(5.5 ±0.8) cm H2O(1 cm H2O =0.098 kPa) vs.(6.2 ± 1.0) cm H2O,(2.8 ± 1.6) L/(min·m2) vs.(3.3 ± 0.8) L/(min·m2),(65.7 ± 4.5) ml vs.(74.3 ± 7.5) ml;control group:(65.4 ± 7.3) mm Hg vs.(85.1 ± 6.6) mm Hg,(4.6 ± 0.8) cm H2O vs.(6.4± 1.1) cm H2O,(2.7 ±0.7) L/(min·m2) vs.(3.3 ±0.6) L/(min·m2),(60.6 ± 7.6) ml vs.(73.8 ±7.5)ml],stroke variation degree (SVV) was significantly increased [test group:(15.9 ±5.1)％ vs.(12.1 ±5.9)％; control group:(15.8 ± 9.4)％ vs.(12.6 ± 8.4)％],there was significant difference (P ＜ 0.05).Compared with the same time of control group,MAP was higher at T3,CI was higher at T4 and T5,SV was higher at T2-T7,there was significant difference (P＜ 0.05).The total transfusion amount,crystal usage and urine in intraoperative and transferred to the ICU 24 h in test group were less than those in control group,while colloid usage was more than that in control group,there was significant difference (P ＜ 0.05).The incidence of cardiac adverse events between two groups had no significant difference (P =0.232).The postoperative ICU stay time,exhaust time,defecation time,into the liquid diets time and hospital stay in test group were less than those in control group [(37 ± 13) h vs.(55 ± 25) h,(72 ± 12) h vs.(99 ± 13) h,(92 ± 16) h vs.(113 ± 16) h,(4.0 ±0.8) d vs.(4.9 ± 1.9) d,(17 ±4) d vs.(27 ±5) d],there was significant difference (P ＜ 0.05 or ＜ 0.01).Conclusion In the elderly patients with coronary heart disease undergoing gastrointestinal surgery,individualized fluid therapy can effectively decrease adverse cardiac events,improve postoperative gastrointestinal function,and reduce length of hospital stay. Key words: Individualized medicine; Perioperative nursing; Surgical procedures operative; Postoperative complications