The Application Of Goal-directed Fluid Therapy In Elderly Patients Undergoing Laparoscopic Radical Cystectomy

Background:Patients with bladder cancer are always elderly patients who combined with a lot of age-related illnesses.Radical cystectomy with urinary bladder is the standard treatment of bladder cancer.But this surgical operation is complex which has a long duration,and the amount of urine is not statistic in the process.All these factors may increase difficulty of perioperative fluid management.Looking for a suitable volume strategy for the elderly is to be a focus in the perioperative period.Goal-Directed Fluid Therapy(GDFT)is an optimal strategy of volume therapy,which carry out transfusion plan according to different volume state of patients.In this study,GDFT was implemented under the monitoring of PiCCO with the target of Stroke Volume Variation(SVV)?13%,Cardiac Index(CI)?2.5 L·min-1·m-2,and Central Venous Oxygen Saturation(ScvO2)?73%,so as to establish its utility in routine clinical practice.Material and Method44 patients aged?60yr with an ASA physical status of ??? who were presenting for elective laparoscopic radical cystectomy were randomly divided into routine fluid replacement group(group C,n = 22)and GDFT group(group G,n = 22).Patients in group C received routine fluid replacement.Group G were treated under goal-directed fluid infusion strategy with the target of SVV?13%,CI?2.5 L·min-1·m-2,and ScvO2>73%under the monitoring of PiCCO.The indexes of hemodynamics and tissue perfusion were collected and recorded at 7 time points:before induction of anesthesia(Ti),5 minutes after intubation(T2),5 minutes after pneumoperitoneum and change of positions(T3),1 hour after pneumoperitoneum(T4),5 minutes after the abdomen was opened(T5),1 hour after the abdomen was opened(T6)and the end of surgery(T7).The indexes of postoperative rehabilitation were also recorded.Results1.General informationIn each group,one patient was excluded from analysis.The other 42 patients successfully completed the operation.Compared with group C,group G received less total fluid and crystal volume,but received more colloid volume.Other demographic data showed no significant differences.2.Hemodynamic indexesThere were no significant differences in any hemodynamic indexes of patients between two groups.MAP in group C at T2,T6 and T7 was significantly lower than that at Ti.MAP in group G at T2 was significantly lower than that at Ti,but at T3 was higher than that at Ti.HR in group C at T2?T7 was significantly lower than that at Ti.HR in group G at T2 was significantly lower than that at Ti.CI in group C at T2?T4 and T6 was significantly lower than that at Ti.SVV in group C at T3?T6 was significantly lower than that at Ti.SVV in group G at T2?T7 was significantly lower than that at Ti.There were no differences in ELWI and PVPI between two groups.3.Perfusion indexesThe aLac in group G at T4 and T5 were significantly lower than that in group C.No differences in ScvO2,Pcv-aCO2,DO2I,and O2ERe could be detected between two groups.4.Postoperative rehabilitation indexesThe time of the postoperative recovery of bowl function and hospitalization between two groups were all no statistically significant.No differences in the score of QOR-15 and KPS could be detected between two groups.All patients survive within 30 days of surgery.No significant differences were detected in any complications between two groups.ConclusionThe application of GDFT with SVV,CI,and ScvO2 in elderly patients undergoing laparoscopic radical cystectomy can decrease the total fluid in the operation,maintain enough CO,keep the effective circulatory volume,and make the hemodynamics more stable.At the same time,it did not increase the risk of pulmonary edema.It can also maintain the whole body perfusion,improve microcirculation and reduce the aLac,without effecting the balance of oxygen supply and demand.But it can not accelerate the postoperative recovery of bowl function or decrease the postoperative complications or improve the early survival quality.