Objective To explore the effects of fluid therapy guided by low stroke volume variation rate (SVV) on gastrointestinal function after lobectomy in elderly patients.
Methods A total of 100 elderly patients, 50 males and 50 females, 65-75 years, BMI 18-24 kg/m2, ASA physical status Ⅱ or Ⅲ, were selected for elective thoracoscopic lobectomy from February 2022 to January 2023. The patients were divided into two groups: low SVV threshold goal-directed fluid therapy (GDFT) group (group G, 8% < SVV ≤ 10%) and control group (group C, 10% < SVV ≤ 13%), 50 patients in each group. Anesthesia time, operation time, and one-lung ventilation (OLV) time were recorded. HR and MAP were recorded immediately after admission to the operating room (T0), immediately after intubation (T1), immediately after the start of OLV (T2), immediately after the operation (T3), immediately after the end of OLV (T4), and after the operation (T5). Intraoperative fluid intake and outflow and the use of various vasoactive drugs were recorded. The concentrations of plasma motilin (MTL), gastrin (GAS), and intestinal fatty acid binding protein (IFABP) were recorded 24 hours before surgery, 24 and 48 hours after surgery. The VAS pain score at rest 2, 6, 12, 24, and 48 hours after surgery, the number of effective PCIA compressions, the total number of PCIA compressions, and the number of relief analgesia within 48 hours after surgery were recorded. The time of the first anal exhaust, the time of the first postoperative defecation, the time of the first postoperative getting out of bed, the time of postoperative hospital stay, and the occurrence of gastrointestinal complications (nausea and vomiting, abdominal distension) were recorded.
Results Compared with group C, MAP were significantly increased at T1-T5, concentrations of plasma MTL and GAS were significantly increased 24 and 48 hours after surgery in group G (P < 0.05), concentrations of plasma IFABP 24 and 48 hours after surgery, intraoperative colloid infusion, and total fluid volume were significantly decreased (P < 0.05), the time of the first postoperative anal exhaust, the time of the first postoperative defecation, the time of the first postoperative getting out of bed, and the postoperative hospital stay were significantly shortened in group G (P < 0.05). There were no significant differences in urine volume, blood loss, VAS pain score at rest 2, 6, 12, 24, and 48 hours after surgery, the number of effective PCIA compressions, the total number of PCIA compressions, and the incidence of relief analgesia within 48 hours after surgery between the two groups.
Conclusion The GDFT with a low SVV threshold (8% < SVV ≤ 10%) can well promote gastric secretion and intestinal mucosal barrier function recovery and has a positive effect on the recovery of gastrointestinal function after pulmonary lobectomy in elderly patients. |
