|
|
|
| Effects of intraoperative goaldirected fluid therapy on postoperative rehabilitation of patients undergoing laparoscopic sleeve gastrectomy#br# |
| WANG Min, YANG Yi, ZHANG Keyao, ZHAI Wenshan, GAO Fang |
（Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu 221000, China）
|
|
|
|
| Guide |
|
Abstract Objective： To compare the postoperative rehabilitation effect of the goaldirected fluid therapy （GDFT) and the restrictive fluid therapy （RFT) for obese patients undergoing laparoscopic sleeve gastrectomy. Methods： Sixty obese patients who underwent elective laparoscopic sleeve gastrectomy under general anesthesia from May to October 2021 in the Affiliated Hospital of Xuzhou Medical University were selected and divided into RFT group （group RFT) or GDFT （group GDFT) according to the random number table method, with 30 patients in each group. The fluctuation of heart rate and mean arterial pressure in group RFT did not exceed the preoperative baseline 20%. Group GDFT used the FloTrac/Vigileo monitoring system to monitor stroke volume variation （SVV), maintaining SVV≤13%. The incidence of postoperative complications in the two groups was observed. Between the two groups, the use of intraoperative vasoactive drugs and the incidence of intraoperative hypotension were compared; the first postoperative anal exhaust time was compared. The scores of gastrointestinal quality of life index （GIQLI) before and after surgery at 2, 5, 10, 16 weeks were compared. Results： Compared with group RFT, the incidence of postoperative complications in group GDFT was significantly reduced （P＜0.05）, the utilization of intraoperative vasoactive drugs and the incidence of intraoperative hypotension were also significantly lower （both P＜0.05), the first postoperative anal exhaust time was significantly earlier （P＜0.01). The GIQLI score in group GDFT was significantly higher than that in group RFT at 2, 5 and 10 weeks after surgery （all P＜0.05). Conclusion： The goaldirected fluid therapy based on the FloTrac/Vigileo can promote postoperative rehabilitation of obesity patients.
|
|
Received: 25 March 2022
|
| Fund: |
|
|
|
［1］NCD Risk Factor Collaboration（NCDRisC). Trends in adult bodymass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 populationbased measurement studies with 19.2 million participants［J］. Lancet, 2016, 387(10026): 1377-1396.
［2］Piché ME, Tchernof A, Després JP. Obesity phenotypes, diabetes, and cardiovascular diseases［J］. Circ Res, 2020, 126(11): 1477-1500.
［3］黄柯, 朱孝成, 姚立彬, 等.腹腔镜袖状胃切除术治疗肥胖合并原发性高血压的疗效分析［J］.徐州医科大学学报,2020,40(9):655-660.
［4］Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery（ERAS) Society recommendations［J］. Clin Nutr, 2012, 31(6): 801-816.
［5］Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery（ERAS) pathway for patients undergoing major elective open colorectal surgery: a metaanalysis of randomized controlled trials［J］. Clin Nutr, 2010, 29(4): 434-440.
［6］Pang Q, Liu H, Chen B, et al. Restrictive and liberal fluid administration in major abdominal surgery［J］. Saudi Med J, 2017, 38(2): 123-131.
［7］Wrzosek A, JakowickaWordliczek J, Zajaczkowska R, et al. Perioperative restrictive versus goaldirected fluid therapy for adults undergoing major noncardiac surgery［J］. Cochrane Database Syst Rev, 2019, 12(12): CD012767.
［8］Hendrix RJ, Damle A, Williams C, et al. Restrictive intraoperative fluid therapy is associated with decreased morbidity and length of stay following hyperthermic intraperitoneal chemoperfusion［J］. Ann Surg Oncol, 2019, 26(2): 490-496.
［9］Deng QW, Tan WC, Zhao BC, et al. Is goaldirected fluid therapy based on dynamic variables alone sufficient to improve clinical outcomes among patients undergoing surgery? A metaanalysis［J］. Crit Care, 2018, 22(1): 298.
［10］Ruszkai Z, Kiss E, László I, et al. Effects of intraoperative PEEP optimization on postoperative pulmonary complications and the inflammatory response: study protocol for a randomized controlled trial［J］. Trials, 2017, 18(1): 375.
［11］吕季阳，李红，韩贺，等．加速康复外科围术期营养管理对胃切除术后肠黏膜屏障的影响［J］.江苏大学学报（医学版）, 2020, 30(6): 531-536.
［12］陈雅洁, 张茂银, 刘畅, 等.术前呼吸功能锻炼对病态肥胖患者全麻苏醒期呼吸功能的影响［J］.徐州医科大学学报, 2020, 40(6): 450-454.
［13］Feldheiser A, Aziz O, Baldini G, et al. Enhanced Recovery After Surgery（ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice［J］. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
［14］Voldby AW, Brandstrup B. Fluid therapy in the perioperative setting—a clinical review［J］. J Intensive Care, 2016, 4: 27.
［15］Jia FJ, Yan QY, Sun Q, et al. Liberal versus restrictive fluid management in abdominal surgery: a metaanalysis［J］. Surg Today, 2017, 47(3): 344-356.
［16］Hamilton MA, Cecconi M, Rhodes A. A systematic review and metaanalysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and highrisk surgical patients［J］. Anesth Analg, 2011, 112(6): 1392-1402.
［17］Pearse RM, Harrison DA, MacDonald N, et al. Effect of a perioperative, cardiac outputguided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review［J］. JAMA, 2014, 311(21): 2181-2190.
［18］Bentzer P, Griesdale DE, Boyd J, et al. Will this hemodynamically unstable patient respond to a bolus of intravenous fluids?［J］. JAMA, 2016, 316(12): 1298-1309.
［19］Messina A, Robba C, Calabrò L, et al. Association between perioperative fluid administration and postoperative outcomes: a 20year systematic review and a metaanalysis of randomized goaldirected trials in major visceral/noncardiac surgery［J］. Crit Care, 2021, 25(1): 43.
|
|
|
|
