Value of GDFT guided by TEE combined with small dose of norepinephrine in the application of laparoscopic colorectal cancer surgery in elderly patients

ObjectiveTo observe the effects of goal-directed fluid therapy(GDFT) guided by transesophageal echocardiography(TEE) combined with small dose of norepinephrine on intraoperative circulation management and postoperative recovery in elderly patients treated with laparoscopic colorectal surgery.

MethodsFifty patients over 60 years scheduled by radical resection of colorectal cancer, ASA grade Ⅰto Ⅱ, were randomly divided into the observation group and control group(25 cases each group).The observation group was treated with GDFT guided by TEE combined with small doses of norepinephrine, and the control group was treated with conventional liquid.The amounts of liquid and norepinephrine in observation group after anesthesia were adjusted according to the blood flow time corrected(FTc) and stroke volume(SV) of the descending aorta monitored by TEE, and the control group was treated with the traditional method fluid infusion.The mean artery pressure(MAP), heart rate(HR) and central venous pressure(CVP) between two groups were compared before anesthesia induction(T₀) and tracheal intubation(T₁), at the time of establishing artificial pneumoperitoneum(T₂), after resecting tumor(T₃), after stopping pneumoperitoneum(T₄) and after extubation(T₅).The crystal/gel ratio and total amount, urine volume, levels of aspertate aminotransferase(AST), alanine aminotransferase(ALT), blood urea nitrogen(BUN) and creatinine(Cr), and incidence rates of adverse reaction and complications during postoperative recovery were recorded in two groups.

ResultsThe amounts of intraoperative urine and balance solution infusion in observation group were significantly less than those in control group(P < 0.01 and P < 0.05), and the amount of polygelatin peptide infusion in observation group was significantly more than that in control group(P < 0.05).The HR and MAP in two groups at T₁ and T₂ decreased compared with at T₀(P < 0.05 to P < 0.01), and the CVP in two groups at T₁ increased compared with at T₀(P < 0.01).Compared with the control group, the HR in observation group increased at T₄ and T₅(P < 0.01), and the CVP in observation group decreased at T₃, T₄ and T₅(P < 0.01).Compared with before operation, the ALT level increased, and the levels of AST and BUN decreased in observation group after operation(P < 0.01).The differences of the levels of ALT, AST, BUN and Cr in control group were not statistically significantly between before and after operation(P>0.05).There was no statistical significance in the incidence rate of adverse reaction between observation group(16.0%) and contorl group(28.0%), and the incidence rate of complications in observation group(8.0%) was significantly lower than that in control group(32.0%)(P < 0.05).

ConclusionsThe GDFT guided by TEE combined with small dose of norepinephrine has advantages in the postoperative recovery of patients treated with laparoscopic colorectal surgery.