Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, No. 32 West Second Section, First Ring Road, Chengdu, Sichuan, China.
North Sichuan Medical College, Nanchong, Sichuan, China.
BMC Anesthesiol. 2021 May 21;21(1):157. doi: 10.1186/s12871-021-01377-8.
The effect of a combination of a goal-directed fluid protocol and preoperative carbohydrate loading on postoperative complications in elderly patients still remains unknown. Therefore, we designed this trial to evaluate the relative impact of preoperative carbohydrate loading and intraoperative goal-directed fluid therapy versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery.
This prospective randomized controlled trial with 120 patients over 65 years undergoing gastrointestinal surgery were randomized into a CFT group (n = 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n = 60) with carbohydrate (200 ml) loading 2 h before surgery. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic data, intraoperative parameters and postoperative outcomes were recorded.
Patients in the GDFT group received significantly less crystalloids fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml; p < 0.001) and produced significantly less urine output (200 ml [150-300] vs 400 ml [290-500]; p < 0.001) as compared to the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (56 ± 14.1 h vs 64 ± 22.3 h; p = 0.002) and oral intake (72 ± 16.9 h vs 85 ± 26.8 h; p = 0.011), as well as a reduction in the rate of postoperative complications (15 (25.0%) vs 29 (48.3%) patients; p = 0.013). However, postoperative hospitalization or hospitalization expenses were similar between groups (p > 0.05).
Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications.
ChiCTR, ChiCTR1800018227 . Registered 6 September 2018 - Retrospectively registered.
关于联合目标导向液体方案和术前碳水化合物负荷对老年患者术后并发症的影响仍不清楚。因此，我们设计了这项试验，以评估术前碳水化合物负荷和术中目标导向液体治疗与传统液体治疗（CFT）对胃肠手术后老年患者临床结局的相对影响。
本前瞻性随机对照试验纳入 120 名 65 岁以上行胃肠手术的患者，随机分为 CFT 组（n=60）和 GDFT 组（n=60）。CFT 组采用传统的禁食和禁水方法，GDFT 组在术前 2 小时给予碳水化合物（200ml）。CFT 组术中常规监测，而 GDFT 组通过脉搏指示连续心排血量监测仪（PiCCO）监测心指数（CI）、每搏量变异度（SVV）和平均动脉压（MAP）。记录所有患者的人口统计学数据、术中参数和术后结局。
GDFT 组患者接受的晶体液明显较少（1111±442.9ml 比 1411±412.6ml；p<0.001），尿量明显较少（200ml[150-300]比 400ml[290-500]；p<0.001）。此外，与 CFT 组相比，GDFT 组患者首次排气时间（56±14.1h 比 64±22.3h；p=0.002）和开始口服时间（72±16.9h 比 85±26.8h；p=0.011）较短，术后并发症发生率较低（15（25.0%）比 29（48.3%）；p=0.013）。然而，两组患者的术后住院时间或住院费用无差异（p>0.05）。
我们发现，对于接受胃肠手术的老年患者，围手术期液体优化可能与改善肠道功能和降低术后并发症发生率有关。
ChiCTR，ChiCTR1800018227。注册日期：2018 年 9 月 6 日-回顾性注册。
