A Clinical Study On Fluid Therapy Guided By Stroke Volume Variation In Elderly Unilateral Hip Replacement Patients

Objective:To explore the effects of fluid therapy guided by stroke volume variation on Circulating hemodynamics,peripheral blood perfusion,and tissue metabolism in elderly unilateral hip replacement patients;clinical evidence was provided for perioperative target-oriented liquid therapy guided by stroke volume variation.Methods:A total of 60 patients who underwent unilateral hip replacement surgery under general anesthesia in our hospital from June to September 2019 were enrolled in this study.All patients had an ASA grade of II~III,and were between ages of 65-80 years old.they were randomly divided into the R group(n = 30)and the SVV group(n = 30).In R group,the routine rehydration volume = physiological requirement amount + fasting loss amount + extra loss amount + blood loss amount + anesthesia expansion volume;the SVV group,liquid management guided by stroke volume variation,maintaining intraoperative SVV at 8~12%.During the operation,the amount of crystals,colloids,total infusion volume,urine volume and blood loss were observed.The change at each point in time about mean arterial blood pressure,heart rate and pulse perfusion index include: basal value(T0),before position change(T1),at the beginning of the operation(T2),30 minutes after the operation(T3),1 hour after the operation(T4),and the end of the operation(T5),5 minutes after extubation(T6)were recorded.The Variety in each period about lactate concentration in plasma include: before the induction of anesthesia(L0),30 minutes after the operation(L1),1 hour after the operation(L2)and before entering the postanaesthesiacare unit(L3)were collected.A bedside chest X-ray examination was performed after operation.The frequency of adverse events about intraoperative hypotension and postoperative complications such as nausea and vomiting,fever,pulmonary edema,and postoperative delirium within 24 hours after surgery were recorded.Results:Compared with the R group,the amount of crystals infused in the SVV group(912.80 ± 168.72 m L and 834.90 ± 81.82 m L;P <0.05)and the amount of colloids(765.47 ± 81.82 m L and 491.23 ± 93.85 m L;P <0.05)were more;The total fluid infusion(1679.10 ± 211.98 m L and 1329.47±135.81 m L;P <0.05)was also larger;the number of hypotension(1 and 7;P <0.05)occurred during the operation,and the frequency of nausea and vomiting(2 and 8;P <0.05)occurred within 24 hours after the operation.Meanwhile,the increase in MAP at T2 and T4 in the SVV group was significant and the difference was statistically significant(P <0.05);the increase in PI at T4,T5,and T6 was significant and the difference was statistically significant(P <0.05);The increase in blood lactic acid concentration at L3 was smaller and the difference was statistically significant(P <0.05).Pulmonary edema was not found in the bedside chest X-ray films of the two groups after surgery,the difference was not statistically significant(P> 0.05);the difference about frequency of other adverse events was not statistically significant(P >0.05).Conclusions:Fluid management guided by SVV was superior to conventional rehydration methods,It better maintained the relatively stable hemodynamics of elderly patients during operation,ensured cell oxygenation,increased peripheral blood perfusion,and reduced the frequency of intraoperative hypotension and complications within 24 hours after the operation.It illustrated the effectiveness and safety of fluid therapy guided by SVV about dynamic volume monitoring indicators in unilateral hip replacement for elderly patients.