| ObjectiveIn lumbar spine surgery,pulse pressure variation-guided goal-directed fluid therapy was compared with conventional fluid therapy to observe whether there were differences in intraoperative hemodynamics,tissue perfusion,fluid use,and quality of early postoperative recovery in patients,thus providing clues to optimize perioperative fluid therapy regimens in prone lumbar spine surgery.MethodsWe selected 66 patients who underwent lumbar surgery under general anesthesia,aged ≥60 years,18.5 kg/m2<BMI<30 kg/m2,ASA grade Ⅰ～Ⅲ.The subjects were randomly divided into two groups:conventional fluid therapy group(group C)and PPV-guided goal-directed fluid therapy group(group G).Group C received conventional fluid therapy,and the amount of fluid replacement included physiological demand,cumulative loss,continued loss and anaesthesia-induced vasodilation.Group G received goal-directed fluid therapy,and pulse pressure variation(PPV)and mean arterial pressure(MAP)were used as monitoring targets to guide fluid therapy.General data of the patients,such as age,sex,height,weight,BMI,ASA grade,hemoglobin value(Hb),were recorded.The hemodynamic indexes(MAP,HR,PPV)were recorded before induction of anesthesia(T1),after changing position(T2),at the beginning of operation(T3),1 h after the beginning of operation(T4),and at the end of operation(T5).The total infusion volume,colloid volume,crystal volume,blood loss,urine volume,use of vasoactive drugs,operation time and anesthesia time were recorded.Arterial blood samples were taken at T1,T4 and T5 for blood gas analysis,and pH value,lactic acid value(Lac)and base excess(BE)were recorded.The 15-item recovery quality scale was used to evaluate the postoperative recovery quality at 1 day before operation,1 day after operation and 3 days after operation.And the first exhaust time and postoperative complications were recorded.Results1.There was no significant difference in sex,age,height,weight,BMI,ASA grade,preoperative Hb level,anesthesia time and operation time between the two groups(P>0.05).2.There was no significant difference in MAP and HR between the two groups at different time points(P>0.05).At the end of operation,the value of PPV in group G was significantly lower than that in group C(P<0.05).3.At the end of operation,the value of Lac in group G was significantly lower than that in group C,and the value of BE in group G was significantly higher than that in group C(P<0.05).4.The total infusion volume and colloid volume in group G were significantly lower than those in group C(P<0.001).The utilization rate of intraoperative hydroxylamine in group G was significantly lower than that in group C(P<0.05).There was no significant difference in crystal volume,blood loss,urine volume and ephedrine utilization rate between the two groups(P>0.05).5.On the first and third postoperative days,the QoR-15 scores of patients in group G were significantly higher than those in group C(P<0.001).6.The first exhaust time in group G was significantly shorter than that in group C(P<0.05).There was no significant difference in the incidence of postoperative nausea and vomiting between the two groups(P>0.05).There were no cardiovascular complications,pulmonary complications and renal function abnormalities in both groups.Conclusion1.In the lumbar surgery of elderly patients,the application of PPV-guided goal-directed fluid therapy can reduce intraoperative fluid infusion,stabilize intraoperative hemodynamics,and improve tissue and organ perfusion.2.In the lumbar surgery of elderly patients,the application of PPV-guided goal-directed fluid therapy can improve the quality of postoperative recovery,shorten the first exhaust time after operation,and accelerate the recovery of gastrointestinal function. |
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