Abstract: Objective To systematically review the effects of intraoperative goal directed fluid therapy (GDFT) on the outcome of elderly patients undergoing gastrointestinal surgery. Methods PubMed, Embase, the Cochrane Library, CNKI, Wanfang and CBM were searched from January 2010 to September 2020 to screen out randomized controlled trials (RCT) concerning the effects of GDFT on the outcome of elderly patients undergoing gastrointestinal surgery. The treatment group received GDFT, while the control group was given routine fluid therapy. The major evaluation indicators included the length of postoperative hospitalization stay, pulmonary complications, cardiovascular complications, nausea and vomiting, the incidences of postoperative cognitive dysfunction (POCD) 3 d after operation, first exhausting time. The secondary evaluation indicator was the content of serum lactic acid. The RevMan 5.3 software was used for Meta analysis. Results A total of 15 RCT studies with a total of 1 146 patients were included, based on the inclusion and exclusion criteria. Compared with the control group, the treatment group presented shortened length of postoperative hospitalization stay [mean difference (MD)=−3.22, 95% confidence interval (CI) −4.50‒−1.93, P<0.01], reduced postoperative pulmonary complications (MD=0.22, 95%CI 0.12‒0.40, P<0.01), decreased cardiac complications (MD=0.29, 95%CI 0.14‒0.61, P<0.01), decreased incidences of nausea and vomiting (MD=0.37, 95%CI 0.17‒0.80, P=0.01), reduced POCD (MD=0.37, 95%CI 0.22‒0.62, P<0.01), shortened time of first postoperative exhausting (GDFT group: MD=−15.09, 95%CI −17.94‒−12.23, P<0.01; GDFT combined with prophylactic vasoconstriction drug group: MD=−14.00, 95%CI −24.64‒−3.36, P<0.05), decreased content of postoperative serum lactic acid (GDFT group: MD=−0.40, 95%CI −0.49‒−0.31, P<0.01; GDFT combined with prophylactic vasoconstriction drug group: MD=−0.70, 95%CI −0.90‒−0.50, P<0.05). Conclusions Intraoperative GDFT can help elderly patients undergoing gastrointestinal surgery to balance the need and supply of oxygen, reduce the incidence of cardiovascular and pulmonary complications, postoperative nausea and vomiting, and postoperative 3‑day POCD, shorten postoperative hospitalization stay, and contribute to postoperative recovery.
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