Effect of goal-directed liquid therapy in thoracoscopic radical resection of esophageal cancer for elderly hypertensive patients

  Objective   To explore the effect of goal-directed fluid therapy(GDFT) using pulse pressure variation(PPV)in thoracoscopic radical resection of esophageal cancer for elderly patients with hypertension.

  Methods   A total of 80 elderly patients with hypertension who underwent thoracoscopic radical resection of esophageal cancer were selected as research objects, these patients were randomly divided into two groups. A total of 37 cases in control group were treated with fluid restriction during the operation. In the observation group, 43 cases were treated with GDFT fluid management under the guidance of PPV during the operation. Intraoperative hemodynamic indexes including mean arterial pressure (MAP), heart rate (HR), cardiac displacement (CO) and cardiac index (CI) were recorded in two groups before anesthesia induction (T₀), at the beginning of pneumoperitoneum establishment (T₁), 1 h after surgery (T₂) and at the end of surgery (T₃). The total amount of intraoperative infusion, intraoperative blood loss, urine volume and the proportion of patients using norepinephrine were compared between the two groups. Arterial partial pressure of oxygen[p_a(O₂)]and arterial partial pressure of carbon dioxide[p_a(CO₂)]were observed 3 days after operation. Postoperative anal exhaust time, postoperative hospital stay and complications were recorded in two groups.

  Results   HR at T₂ and T₃ in the observation group was lower than control group, indicators such as MAP, PPV, CO, and CI were higher than that in the control group, intraoperative total fluid volume and urine volume were less than those in the control group, and the proportion of patients receivingnorepinephrine was lower than that in the controlgroup (P < 0.05). Postoperative p_a(O₂) in the observation group at 1, 3 d was higher than that in the control group, p_a(CO₂) was lower than the control group, complication rates of postoperative pain, nausea, vomiting, cough, and sputum were lower than those in the control group, the exhaust time and postoperative hospital stay were shorter than those in the control group (P < 0.05).

  Conclusion   GDFT using PPV in thoracoscopic radical resection of esophageal cancer for elderly patients with hypertension can better complete intraoperative fluid management, have faster recovery of gastrointestinal function after surgery, and fewer complications.