The Effects Of Goal-directed Fluid Therapy On Cerebral Regional Oxygen Saturation And Postoperative Cognitive Function In Elderly Patients Undergoing One-lung Ventilation In Radical Resection Of Esophageal Cancer

Objective:To observe the effect of goal-directed fluid therapy on cerebral regional oxygen saturation and postoperative cognitive function in elderly patients undergoing one-lung ventilation after radical resection of esophageal cancer.Methods:Elderly patients undergoing radical resection of esophageal cancer with right one lung ventilation（OLV）and OLV under general anesthesia in the The second affiliated Hospital of Nanchang University from July 2021 to December 2021 were randomly divided into control group（group C）and experimental group（group G）.The control group was treated with routine fluid replacement,and the experimental group was treated with goal-directed fluid therapy guided by stroke volume variation（SVV）.The mean arterial pressure（MAP）,heart rate（HR）and cerebral regional oxygen saturation（r SO2）were recorded before anesthesia induction（T₀）,at the moment of one-lung ventilation（T₁）,30min after one-lung ventilation（T₂）,1 hour after one-lung ventilation（T₃）,2 hours after one-lung ventilation（T₄）and 5min after endotracheal extubation（T₅）,and the minimum value of r SO₂（r SO₂min）and the maximum percentage of decrease of r SO₂compared with the basal value（r SO₂max）were recorded.The cognitive function scores of patients with Mini-mental state examination（MMSE）were recorded at 1 day before operation（D₀）,1 day after operation（D₁）,3 days after operation（D₂）and 7 days after operation（D₃）.Central venous blood samples were collected before anesthesia induction（T₀）,1 hour after one lung ventilation（T₃）,5min after tracheal extubation（T₅）,1 day after operation（D₁）,3 days after operation（D₂）and 7 days after operation（D₃）.Serum tumor necrosis factorα（TNF-α）and interleukin-6（IL-6）levels were measured.The postoperative MMSE score decreased by more than 2 points was regarded as Postoperative Cognitive Dysfunction（POCD）.Results:A total of 72 cases were included in this study,and finally 60 cases were included for statistical analysis,30 cases in each group.There was no significant difference in sex ratio,age,body mass index（BMI）,the grade of American Society of Anesthesiologists（ASA）,total operation time,OLV duration time and total hospitalization expenses between the two groups.In group G,the crystalloid solution volume,urine volume and vasoactive drug dosage decreased significantly,while colloid volume increased significantly（P<0.05）,but there was no significant difference in blood transfusion,total transfusion volume and blood loss（P>0.05）.The data of two groups at multiple time points in this study were all related to the interaction of group,time,time and group by repeated measurement variance test（P<0.05）.The incidence of POCD in group G was lower at three time points after operation（P<0.05）.The MMSE score of both groups decreased significantly at D₁compared with D₀,and increased at D₂and D₃,but the increase was not the same.MAP decreased significantly in both groups during T₁～T₄,and slightly increased at T₄compared with T₄,but there was no significant difference between the two groups at T₀and T₁（P>0.05）.As far as HR was concerned,compared with T₀,the level of HR in C group increased at T₁,while that in G group decreased,but there was no significant difference（P>0.05）,it increased in both groups at T₂-T₄and slightly decreased compared with T₄at T₅（P<0.05）.The change trend of IL-6 and TNF-αimages was almost the same,the T₀-T₅curve showed an upward phase,while D₁-D₃decreased,but did not return to the preoperative state,and the decreasing and ascending trend of group G was slower than that of group C at the same time.Compared with T0,the r SO₂of the two groups increased significantly at T₁,and the amplitude of the experimental group was slightly higher than that of the control group;at T₂-T₄,the two groups showed a downward trend,the amplitude was roughly the same,and slightly increased at T₅.The mean regional cerebral oxygen saturation（r SO₂m）and intraoperative lowest cerebral oxygen saturation（r SO₂min）in group G were higher than those in group C,while the maximum percentage of decrease of r SO₂compared with the basal value（r SO₂max）in group G was lower than that in group CConclusion:GDFT can stabilize the perioperative hemodynamic parameters of elderly patients undergoing one-lung ventilation after radical resection of esophageal cancer,improve cerebral circulation and oxygen supply during OLV,maintain the balance of fluid intake in elderly patients during perioperative period,effectively reduce the incidence of inflammatory reaction and brain injury,and reduce the incidence of early postoperative POCD in elderly patients with one-lung ventilation.