The Relationship Between Intraoperative GDFT And PND In Elderly Patients With Colorectal Tumors Based On RSO₂ Monitoring

Objective:To observe the effect of goal directed fluid therapy combined with regional oxygen saturation on early postoperative cognitive function in patients undergoing radical resection of colorectal tumors.Methods:A randomized prospective controlled experimental study was used to select 80patients aged 60-90 and ASAI-III for elective radical resection of colorectal tumors in the first affiliated hospital of Chengdu Medical College from october 2018 to october2019.were divided into the goal-directed fluid therapy group（G group,n=40）and the tradition fluid therapy group（C group,n=40）using a random digital table method.goal-directed fluid therapy was guided by cardiac output index（CI）and stroke volume variation（SVV）,the C group performed fluid therapy guided by MAP,CVP,urine volume during operation.Intravenous controlled analgesia was performed with the same formula.patients were observed and recorded 5 min after entering the operating room（T0）,60min（T1）,120 min（T2）,180 min（T3）,and at the end of the operation（T4）,recorded heart rate（HR）,mean arterial pressure（MAP）,left brain oxygen saturation（LrSO₂）,and right brain oxygen saturation（RrSO₂）.At T0,30 minutes（T5）,24 hours（T6）,72 hours after operation.（T7）.the serum IL-1β,IL-6,TNF-ɑ,S100β,NSE,Uch-L1were measured.Patients were subjected to neuropsychological tests with the Montreal Cognitive Assessment Scale（MoCA）version 3.0 on 1 day before operation（D1）,1week after the surgical（D7）and 1 month after the surgical（D30）.At the same time,the intraoperative crystal volume,colloid volume,bleeding volume,urine volume,operation time,the first exhaust time after operation,the first defecation time,and the postoperative hospitalization time were recorded.Results:（1）This study included 80 patients who met the inclusion criteria,5 patients who were excluded and withdrawn,and the final study included analysis of 75 patients（38 in G group and 37 in C group）.There was no significant difference in the general data of perioperative period such as age,sex,ASA grade,body mass index,years of education,tumor type and operation time between the two groups（P>0.05）.（2）The MAP、HR、rSO₂ of patients at different time points during operation was different from that before operation（P<0.05）.The rSO₂ of the goal-directed fluid therapy group was higher than that of the tradition fluid therapy group,but the MAP、HR was lower than that of the tradition fluid therapy group,and the difference was statistically significant（P<0.05）.（3）The concentration of serum IL-1β,IL-6,TNF-α,S100β,NSE in G group was lower than that in C group（P<0.05）.the serum IL-1β,IL-6,TNF-α,S100β,NSE concentrations were different in the two groups at different time after operation（P<0.05）;serum Uch-L1 levels were basically the same in the two groups after operation,the difference was no statistical difference（P>0.05）.serum Uch-L1 concentrations were higher at different time points than those before operation,and the difference was statistically significant（P<0.05）.（4）The incidence of PND in one week after operation was 29.33%,of which the G group was 7 cases（18.42%）and the C group was 15 cases（40.54%）,G group was significantly lower than C group,The incidence of PND was 20%in 30 days after operation,4 cases in G group（10.53%）and 11 cases in C group（29.73%）,G group remained significantly lower than C group,the difference between the two groups was statistically significant（P<0.05）.compared with the tradition fluid therapy group,the MoCA score was significantly increased in the G group at each postoperative time point.（5）The first exhaust time,defecation time and postoperative hospitalization time of patients in G group were all shorter than those in C group,the difference was statistically significant（P<0.05）.Conclusion:（1）Goal-directed fluid therapy can reduces the incidence of PND in elderly patients undergoing radical resection of colorectal tumors.（2）Goal-directed fluid therapy can reduce perioperative inflammatory response and brain injury in patients undergoing radical resection of colorectal tumor.（3）Goal-directed fluid therapy can Target-oriented fluid therapy can stabilize hemodynamic state in patients undergoing radical resection of colorectal tumor,improve tissue and organ perfusion,optimize the balance of oxygen supply and demand,and improve oxygen saturation of tissue and organ.（4）The goal-directed fluid therapy strategy can improve the recovery of gastrointestinal function and shorten the hospitalization time.