GDFT for GI function following major abdominal surgery

Goal-directed fluid therapy (GDFT) may improve gastrointestinal (GI) function after surgery. However, the evidence for beneficial effects of GDFT for recovery of GI function remains controversial. The aim of this study was to evaluate the effect of GDFT on recovery of GI function in patients undergoing major abdominal surgery.
Materials and Methods In this randomized controlled trial, adult patients scheduled for elective major abdominal surgery with general anesthesia, were randomly divided into GDFT group and control group with standard routine care. In the GDFT group, intraoperative fluid infusion was administered according to stroke volume variation (SVV) and cardiac output index (CI) with the goal of maintaining SVV＜12% and CI≥2.5 L·min-1·m-2. POGD was evaluated by Intake, Feeling nauseated, Emesis, physical Exam, and Duration of symptoms (I-FEED) score system and defined as I-FEED score≥6. Time to the first flatus, time to first tolerate oral diet, and the length of hospital stay were also recorded.
Results One hundred patients completed the study protocol. Two of 50 patients (4%) developed POGD in the GDFT group, whereas POGD occurred in 16 of 50 patients (32%) in the control group (P<0.0001). GDFT significantly shortened time to first flatus by 11 hours (P=0.009) and time to first tolerate oral diet by 2 days (P<0.0001). Moreover, the length of hospital stay was significantly shorter in GDFT group compared with the control group (12 days in GDFT group versus 15 days in control group, P=0.001).
Conclusions GDFT guided by SVV and CI could accelerate the postoperative recovery of GI function and shorten length of hospital stay following major abdominal surgery.

目标导向液体治疗（Goal-directed fluid therapy, GDFT）或可改善术后胃肠（gastrointestinal, GI）功能。然而，关于GDFT对胃肠功能恢复的有益效应的相关证据仍存在争议。本研究旨在评估目标导向液体治疗对大型腹部手术患者胃肠功能恢复的影响。

材料与方法：本研究为随机对照试验，将拟接受全身麻醉下择期大型腹部手术的成年患者随机分为GDFT组与采用标准常规护理的对照组。GDFT组术中补液以每搏量变异度（stroke volume variation, SVV）和心指数（cardiac output index, CI）为指导，目标为维持SVV＜12%且CI≥2.5 L·min⁻¹·m⁻²。术后胃肠功能障碍（postoperative gastrointestinal dysfunction, POGD）采用进食量、恶心感、呕吐、体格检查、症状持续时间（Intake, Feeling nauseated, Emesis, physical Exam, and Duration of symptoms, I-FEED）评分系统进行评估，以I-FEED评分≥6分作为POGD的判定标准。同时记录首次排气时间、首次耐受经口饮食时间及住院时长。

结果：本研究共纳入100例完成试验方案的患者。GDFT组50例患者中仅2例（4%）发生POGD，而对照组50例患者中有16例（32%）发生POGD（P<0.0001）。GDFT可使首次排气时间显著缩短11小时（P=0.009），首次耐受经口饮食时间显著缩短2天（P<0.0001）。此外，GDFT组患者的住院时长较对照组显著缩短（GDFT组为12天，对照组为15天，P=0.001）。

结论：以SVV和CI为指导的目标导向液体治疗可加速大型腹部手术后患者的胃肠功能术后恢复，并缩短住院时长。