Clinical Application Of Goal-oriented Fluid Therapy Guided By Continuous Non-invasive Blood Pressure Monitoring System (CNAP) In Elderly Hip Replacement Surgery

Objective:By comparing perioperative goal-directed fluid therapy and traditional experience rehydration to elderly patients undergoing hip arthroplasty,intraoperative circulatory hemodynamics,infusion volume,arterial blood lactate value,intraoperative hypotension and complications within 24 hours after surgery The impact of occurrence,objectively evaluate whether goal-oriented fluid therapy can reduce hemodynamic fluctuations and postoperative complications in elderly patients during perioperative period,improve microcirculation,and promote patient recovery,so as to provide safer and more effective treatment for elderly patients during perioperative period.The fluid therapy provides clinical evidence.Methods:A total of 60 elderly patients undergoing unilateral hip arthroplasty under elective general anesthesia at Changchun University of Traditional Chinese Medicine Hospital and Jilin Provincial People’s Hospital from December 2019 to December 2020 were selected to participate in the study,and they were over 65 years old in the United States The Association of Anesthesiologists is graded Ⅱ to Ⅲ.They were randomly divided into the traditional experience fluid rehydration R group(n=30)and the goal-oriented fluid therapy-guided fluid rehydration GDFT group(n=30).Among them,the R group was given traditional experience rehydration program;the GDFT group realized fluid management under the guidance of goal-oriented fluid therapy.Observe the total infusion volume,crystal fluid volume,colloidal fluid volume,bleeding volume,and urine volume of the two groups of patients during the operation;record the time points of the two groups of patients: the basic value of entering the operating room(T0),after anesthesia(T1),the beginning of the operation At time(T2),1 hour after the start of the operation(T3),and after the end of the operation(T4),the arterial systolic blood pressure,diastolic blood pressure,mean arterial blood pressure(MAP),and heart rate(HR).The arterial blood lactate of the patient was measured before induction of anesthesia(L0),1 hour after the start of surgery(L1),and before being sent to the recovery room(L2).The frequency and dosage of intraoperative vasoactive drugs were recorded for the two groups of patients;intraoperative hypotension events and the frequency of complications within 24 hours after surgery were observed.Results:Comparing the intraoperative fluid input of patients between different groups,compared with the R group,the intraoperative colloidal fluid input(846.67 ± 298.37 and581.67 ± 284.79;P <0.05)of the GDFT group increased,while the crystal fluid volume of the GDFT group(473.33±147.66 and 577.00±379.41;P <0.05)and total infusion volume(1390.00±345.90 and 1726.33±438.39;P <0.05)were lower than those in group R;at the same time,patients in GDFT group were at the two time points of T1 and T3 The decrease in MAP and HR was smaller,and the hemodynamics was more stable,which was statistically significant(P <0.05);and the postoperative blood lactic acid concentration in the GDFT group increased less than before the operation,which can improve the microcirculation,which is statistically significant(P <0.05).The frequency of intraoperative hypotension in the GDFT group(2 and 7;P <0.05)and the frequency of nausea and vomiting within 24 hours after surgery(2 and 8;P <0.05)were lower than those in the R group.No pulmonary edema was found in postoperative bedside chest X-rays in the two groups,which was not statistically significant(P>0.05);the frequency of complications such as postoperative fever and postoperative delirium was not statistically significant(P>0.05).Conclusion: Compared with traditional empirical fluid therapy,GDFT guided by the CNAP monitoring system can effectively optimize the total amount of fluid and the ratio of lens to colloid during hip replacement in elderly patients,and better maintain the relative stability of intraoperative hemodynamics in elderly patients.Enhance tissue metabolism,reduce intraoperative hypotension and 24-hour postoperative complication rate,prove the effectiveness and safety of target-oriented fluid therapy in unilateral hip arthroplasty in the elderly,and it is a kind of fluid therapy than traditional empirical fluid therapy.Program A better volume treatment program.