Abstract: Objective To investigate the effect of goal directed fluid therapy (GDFT) on postoperative gastrointestinal function in patients undergoing robot‑assisted laparoscopic radical prostatectomy (RARP). Methods A total of 123 patients, aged 65 years or older, of American Society of Anesthesiologists (ASA) physical status Ⅰ−Ⅲ, without a history of abdominal surgery, scheduled for RARP under general anesthesia, were included and divided into two groups according to the random number table method: conventional liquid therapy group (group C, n=61) and GDFT group (group G, n=62). On the basis of the same anesthetic drugs used in the two groups, fluid therapy for patients in group C was given according to experience and mean arterial pressure (MAP), while in group G was given in line with the pulse pressure variation (PPV) information and MAP. The operation time, anesthesia time, crystalloid volume, colloidal volume, liquid intake and output, blood loss, urine volume, fentanyl and remifentanil dosage, the utilization rate of noradrenaline (NE) were recorded. Heart rate, MAP, pH, lactic acid (Lac), and PaCO2 were recorded at the same time before the operation (T1), tumor removal (T2), and the end of surgery (T3). C‑reactive protein (CRP), creatinine(Cr), and glomerular filtration rate (eGFR) were measured before and after the operation. The recovery time of postoperative exhaust and defecation, the Numerical Rating Scale (NRS) score during 24 h and 48 h after surgery, length of postoperative hospital stay and postoperative complications were recorded. Results Compared with group C, the amount of crystal liquid, colloidal liquid, liquid intake and output decreased in group G (P<0.05); the utilization rate of NE increased (P<0.05); MAP rised at T3 (P<0.05); the postoperative CRP level declined (P<0.05) and the recovery time of gastrointestinal autonomic ventilation and defecation function shortened (P<0.05). There was no significant difference between the two groups in operation time, anesthesia time, blood loss, urine volume, fentanyl and remifentanil dosage, heart rate, pH, Lac, PaCO2, Lac, preoperative CRP, Cr and eGFR, postoperative Cr and eGFR, NRS score within 24 h and 48 h, postoperative hospital stay and postoperative complications (P>0.05). Conclusions The intraoperative strategy of GDFT guided by PPV can reduce the postoperative inflammatory response, reduce the recovery time of spontaneous ventilation and defecation and promote the recovery of gastrointestinal function for patients with RARP who were aged 65 years or older, of ASA physical status Ⅰ−Ⅲ, without a history of abdominal surgery.
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