Analysis on the application value of goal-directed fluid therapy in patients undergoing laparoscopy-assisted radical gastrectomy with fast-track anesthesia.

Objective: To explore the application value of goal-directed fluid therapy (GDFT) in patients undergoing laparoscopy-assisted radical gastrectomy with fast-track anesthesia.

Methods: From December 2016 to December 2019, 74 patients who underwent laparoscopy-assisted radical gastrectomy under the concept of enhanced recovery after surgery (ERAS) in gastrointestinal Surgery department of Tongling People's Hospital were selected as research participants. They were divided into two groups: the routine group (patients were treated with conventional fluids) (n=37) and the GDFT group (patients were treated with GDFT) (n=37). In the two groups, patients were compared in terms of intraoperative fluid inflow and outflow, hemodynamic indexes before operation for 30 min (T0), after anesthesia induction for 30 min (T1), during operation for 0.5 h (T2) and 1.5 h (T3) and after operation (T4), postoperative complications, postoperative recovery, mini-mental state examination (MMSE) scores on the first day (d0) before operation and the first day (d1), the third day (d2) and the seventh day (d3) after operation, and inflammatory factor levels.

Results: The amount of crystal input, colloid, blood loss, fluid replacement and urine volume in the GDFT group were significantly less than those in the routine group (P < 0.05). From T1 to T4, the values of mean arterial pressure (MAP) and central venous pressure (CVP) in the GDFT group were higher than those in the routine group (p < 0.05). The total incidence of postoperative complications in the GDFT group was lower than that in the routine group (P < 0.05). Compared with those in the routine group, the postoperative anus exhaust time, the first time of starting to eat, the time of leaving bed, the duration of stay in the postanesthesia care unit and the hospital stay were significantly shorter in the GDFT group (P < 0.05). From D1 to D3, the MMSE score in the GDFT group was higher than that in the routine group, while the levels of C-reactive protein (CPR), interleukin 6 (IL-6) and procalcitonin (PCT) were lower than those in the routine group (P < 0.05).

Conclusion: GDFT has a better effect on the rapid rehabilitation of patients undergoing laparoscopy-assisted radical gastrectomy during fast-track anesthesia, and it also has a positive effect on maintaining the stability of hemodynamics, reducing systemic inflammation and decreasing postoperative complications.