Study Of Goal-directed Fluid Therapy Combined With Methoxamine In The Perioperative Fluid Management Of Ovarian Cancer Patients

Objective:Ovarian cancer surgery is one of the common high-risk surgeries due to its complex operation,long duration,extensive trauma,high bleeding,fluid transfer,and the possibility of involving multiple organs and tissues,which brings great challenges to perioperative anesthesia management.At present,there is no clear conclusion at home and abroad on which modality of fluid therapy can be more preferably applied to ovarian cancer patients.The purpose of this study is to investigate the effect of goal-directed fluid therapy combined with methoxamine in the perioperative of ovarian cancer patients.Methods:Patients undergoing ovarian cancer debulking surgery at the Third Affiliated Hospital of Kunming Medical University from December 2019 to December 2020 were selected.All enrolled patients were randomly divided into three groups:traditional liquid therapy group（group C）,goal-directed liquid therapy group（group G）,and goal-directed liquid therapy combined with methotrexate group（group GA）.General information such as gender,age,body mass index（BMI）,and ASA classification of patients in the three groups were recorded.The heart rate（HR）,mean arterial pressure（MAP）,stroke volume variability（SVV）,cardiac output（CO）,cardiac index（CI）,stroke volume（SV）,and stroke volume index（SVI）at each time point before induction（T₀）,2 min after induction（T₁）,the beginning of surgery（T₂）,1h during surgery（T₃）,2h during surgery（T₄）,and the end of surgery（T₅）were recorded for the three groups.The systemic vascular resistance index（SVRI）and oxygen transport index（DO2I）were recorded in the three groups of patients at the moment of T₀ and T₅.Arterial blood was drawn for blood gas analysis and lactate values were recorded at T₀ and T₅ in the three groups of patients.The anesthesia time,operation time,extubation time,crystalloid volume,colloid volume,total infusion volume,bleeding volume,urine volume,and intraoperative vasoactive drug use were recorded for the three groups of patients.The glutathione transaminase（ALT）,glutathione aminotransferase（AST）,albumin（Alb）,direct bilirubin（DBIL）,total bilirubin（TBIL）,blood urea nitrogen（BUN）and creatinine（Cr）of preoperative and postoperative day 1,3 were recorded.The occurrence of complications,time of first anal discharge,time of first bowel movement,time of first food intake,and postoperative hospital stay within three days after surgery were recorded for the three groups.Results:1.There was no significant difference between the three groups in terms of general information such as age,height,weight,and body mass index（P>0.05）.There was no significant difference between the three groups in terms of anesthesia time,operation time,and extubation time（P>0.05）.2.HR was slower in all three groups of patients from T₁ to T₅ moments compared to T₀ moments（P<0.05）.There was no significant difference in HR between the three groups of patients compared at different time points（P>0.05）.At the T₅ moment,MAP,CO,CI,SV,SVI,and SVRI of patients in the GA group were higher than those in the remaining two groups（P<0.05）.At T₄ and T₅ moment,SVV was higher in patients in the G and GA groups than in the C group（P<0.05）.3.There was no significant difference in the amount of bleeding in the three groups compared（P>0.05）.The amount of crystals,total infusion volume and urine volume were reduced in group G and GA compared with group C（P<0.05）.The amount of crystals,colloid volume and total infusion volume were reduced in group GA compared with group G（P<0.05）.Intraoperative phenylephrine and ephedrine use was less in group GA than in the other two groups（P<0.05）.4.Lac at T₅ was higher in the three groups compared to T₀（P<0.05）.Lac at T₅ was lower in the GA group compared to the other two groups（P<0.05）.Compared with the T₀,DO2I at the T₅ was higher in the G group and GA group（P<0.05）.DO2I at T₅ was higher in the GA group than in the other two groups（P<0.05）.5.ALT and AST were elevated in the three groups 1 day after surgery（P<0.05）.ALT and AST were significantly lower in group G and GA than group C 3 days after surgery（P<0.05）.Alb decreased in the three groups on the 1st day after surgery compared with that before surgery（P<0.05）.Alb increased faster in the GA group than in the other two groups on the 3rd day after surgery（P<0.05）.Compared with the preoperative period,DBIL and TBIL in the three groups had a slight increase on postoperative day 1（P<0.05）.DBIL and TBIL in the GA group decreased more than the other two groups on postoperative day 3（P<0.05）.There was no significant difference in BUN between the three groups before surgery,1 day after surgery and 3 days after surgery（P>0.05）.Cr decreased in the G group and GA group on 1 day after surgery and 3 days after surgery compared with that before surgery,and the difference was statistically significant（P<0.05）.6.Patients in the GA group had shorter postoperative time to first exhaustion,first defecation,first feeding,and postoperative hospital stay than the other two groups（P<0.05）.In terms of postoperative complications,the incidence of PONV,hypotension,cough and sputum in the GA group was lower than that in the other two groups（P<0.05）.Conclusion:Based on the results of the current study,in the perioperative management of ovarian cancer patients,compared to conventional fluid therapy and goal-directed fluid therapy:1.The combination of methoxamine and goal-directed fluid therapy strategy is more conducive to optimizing fluid infusion,maintaining intraoperative hemodynamic stability,ensuring good perfusion of tissues and organs,and increasing the body’s oxygen supply while reducing total fluid volume.2.Goal-directed fluid therapy combined with methoxamine reduce liver and kidney function damage,accelerates recovery of gastrointestinal function,shortens postoperative hospital stay,and reduces the incidence of postoperative complications.