目標(biāo)導(dǎo)向液體治療方案聯(lián)合術(shù)前碳水化合物負(fù)荷法對(duì)老年患者術(shù)后并發(fā)癥的影響尚不清楚,；因此，設(shè)計(jì)此項(xiàng)試驗(yàn)來評(píng)估術(shù)前碳水化合物負(fù)荷法聯(lián)合術(shù)中目標(biāo)導(dǎo)向液體治療（GDFT）與常規(guī)液體療法(CFT)對(duì)老年患者胃腸道手術(shù)臨床預(yù)后的影響,。

試驗(yàn)納入120例年齡大于65歲的胃腸道手術(shù)患者,，隨機(jī)分為CFT組(n= 60)和GDFT組(n=60),；CFT組采用傳統(tǒng)的禁飲、禁食方法,，而GDFT在手術(shù)前2 h服用碳水化合物(200ml);CFT組術(shù)中進(jìn)行常規(guī)監(jiān)測(cè),，而GDFT組采用Vigileo/FloTrac監(jiān)測(cè)儀監(jiān)測(cè)心臟指數(shù)(CI)、每搏量變異(SVV)和平均動(dòng)脈壓(MAP),，記錄所有患者的人口統(tǒng)計(jì)學(xué)數(shù)據(jù)、術(shù)中參數(shù)及術(shù)后結(jié)果,。

GDFT組與CFT相比：術(shù)中輸入晶體液量明顯減少(1111±442.9 ml 與 1411±412.6 ml,；p<0.001)，尿量明顯減少為(200ml[150–300] 與400ml[290–500],；p< 0.001),；此外，GDFT組首次排氣較短為(56±14.1h 與 64 ±22.3 h; p= 0.002),，口服攝入量時(shí)間為 (72±16.9h 與 85±26.8 h; p=0.011)平均時(shí)長更短,，還可降低患者術(shù)后并發(fā)癥的發(fā)生率(15 (25.0%) 與 29(48.3%) p=0.013)；且兩組間患者住院費(fèi)用差異無統(tǒng)計(jì)學(xué)意義(p>0.05),。

對(duì)于進(jìn)行開放胃腸道手術(shù)的老年患者,，本研究發(fā)現(xiàn)圍術(shù)期優(yōu)化液體治療可能與改善胃腸功能和降低術(shù)后并發(fā)癥相關(guān)。

Preoperative carbohydrate loading andintraoperativegoal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.