Application Of Goal-directed Fluid Therapy Guided By Stroke Volume Variation In Laparoscopic Colorectal Surgery

Background and Objective:The steady state of hemodynamics in patients,suffered laparoscopic colorectal surgery,was affected by the preoperative intestinal preparation,pneumoperitoneum,the change of position,anesthetics and surgical stimulation during the operation.Intraoperative volume management is one of the important factors to ensure stable hemodynamics.Compared with the conventional fluid therapy scheme,fluid was administered individually on the goal-directed fluid therapy scheme according to the dynamic hemodynamic parameters of the patients during the operation to ensure that every patient could keep the optimal state of stroke output.This scheme is widely used in fluid management on operations of urinary surgery,gynecological and etc.For now,it is rarely reported that fluid management guided by stroke volume variation is used in laparoscopic colorectal surgery.In this trail,we used two protocols in patients who suffered laparoscopic colorectal surgery,by observing the effect of the two protocols,postoperative recovery,the incidence of complications and other aspects,to evaluate the impact of postoperative recovery by using goal-directed fluid therapy guided by stroke volume variation.Methods:The 80 patients,underwent elective laparoscopic colorectal surgery from June 2020 to December 2020,were randomly divided into two groups:the conventional fluid therapy group（A group）and the goal-directed fluid therapy guided by stroke volume variation（B group）.Radial artery catheter and central venous catheter were inserted into all patients under the local anesthesia,then we connected monitoring instrument and Flotrac/Vigileo to monitoring heart rate（HR）,invasive blood pressure（IBP）,central venous pressure（CVP）,stroke volume（SV）,cardiac output（CO）,stroke volume variation（SVV）,cardiac index（CI）and other hemodynamic parameters continuously.Fluid protocols were started with induction of anesthesia.The patients of A group adopted the principle of"4-2-1"for perioperative fluid supplement.Crystalloid fluid were infused under 5 ml/kg/h to the patients of B group,then according to the numerical value of SVV to supplement the colloid fluid.When the SVV is greater than or equal to 13%,200ml colloid fluid were induced to patients within 10 min and then evaluated again.If the value of SVV was still more than 13%,the colloid fluid were continued to induced;if the SVV is less than 8%the colloid fluid were stopped;When the SVV was between 8%and 12%,if the augment of SV was over than 10%,200ml colloid fluid were induced to patients again,if not,the colloid fluid were stopped.Inhalation anesthetic combining intravenous anesthetics were used to patients during the time of anesthesia maintenance.The tidal volume of mechanical ventilation was set up 8～10 ml/kg,maintaining P_ETCO₂ from 35 to 45 mm Hg by controlling the respiratory frequency.IBP,HR,CI,CO,SV,SVV and CVP were respectively recorded before induction of anesthesia（T1）,after 3min to induction of anesthesia（T2）,after 5min to pneumoperitoneum（T3）,after 5min to the change of position（T4）,in the first hour of the surgery（T5）,after 5min to the end of pneumoperitoneum（T6）,after 5min to the 2nd pneumoperitoneum（T7）,after 5min to the end of 2nd pneumoperitoneum（T8）,the time to the end of anesthesia（T9）.Before and after operation,arterial blood was extracted for blood gas analysis,observing the changes of ions and lactic acid.Patients were removed to ICU for further treatment with trachea cannula.The patient’s treatments in the ICU and the general ward were recorded.The first time after the patient exhausting,defecation,the time of water and food intake,any other complications and auxiliary examination.Results:There was no significant difference in general data between the two groups（p>0.05）,the variation trend of hemodynamic parameters was similar between the two groups,there was no difference between the two groups,but the change of the B group was stable compared with the A group;The central venous pressure in B group was significantly higher than it in B group（p<0.05）,The values of CVP between the two groups changed significantly following the change of pneumoperitoneum and posture（p<0.05）.There was no difference on the use of vasoactive drug between the two groups（p>0.05）,the total amount of infusion and crystal volume in A group was significantly higher than that in B group（p<0.01）,and there was no difference in intraoperative urine volume,colloid volume,ICU volume,urine volume of ICU,drainage fluid and the time of extubation（p>0.05）.The value of Hb after operation between the two groups was lower than them before operation（p<0.01）,the postoperative Lac of the A group was significantly higher than that before operation（p<0.01）,and there was no significant change in the Lac of the B group（p>0.05）.The values of PT and APTT between the two groups were higher than those before operation.At the day of accomplishing surgery,the values of PT and APTT of the A group were significantly higher than B group（p<0.01）.There was no difference in the incidence of postoperative complications between the two groups,but the incidence of total complications in A group was higher than that in B group（p<0.05）.The 1st postoperative exhaust time（p=0.0497）,the first time of activity（p=0.03）,the 1st time of water and food intake（p=0.02）,and the total number of days in hospital（p=0.045）,which were all B group,were earlier than those in the A group.There was no difference in the 1st time of defecation between the two groups（p>0.05）.Conclusion:1.Central venous pressure is affected by carbon dioxide pneumoperitoneum and posture during laparoscopic colorectal surgery,it can not accurately judge the volume state of the body during the operation.2.Compared with the traditional fluid therapy,the goal-directed fluid therapy guided by SVV uses less total fluid volume in laparoscopic colorectal surgery,but it can still make the tissues and organs get satisfactory perfusion,maintain intraoperative hemodynamic stability and be beneficial to reduce the probability of hypoxia in local tissues.3.Compared with the traditional fluid therapy,the goal-directed fluid therapy guided by SVV is beneficial to the early recovery of patients,who are underwent laparoscopic colorectal surgery,reducing the total incidence of postoperative complications and shortening the length of stay after surgery.