The effect of goal-directed fluid therapy on endothelial glycocalyx and short-term postoperative recovery quality in older patients undergoing laparoscopic hernia or gallbladder surgery: a randomized controlled double-blind clinical study

BackgroundThis study aimed to observe the effects of intraoperative goal-directed fluid therapy on postoperative recovery in older patients undergoing laparoscopic hernia or gallbladder surgery.MethodsA total of 60 older patients were randomly assigned to the control group (C group) and the goal- directed fluid therapy group (G group). The primary outcome was the plasma concentration of syndecan-1. The secondary outcomes were the plasma concentrations of tumor necrosis factor alpha (TNF-α), interleukin-1 (IL-1), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1); mean arterial pressure; heart rate; regional cerebral oxygen saturation; intraoperative dopamine dosage; QoR-15 scale score; hematocrit; and postoperative adverse events.ResultsCompared with the C group, the G group showed decreased plasma concentrations of ICAM-1 at the end of surgery and 24 h after surgery (P = 0.010 and 0.005, respectively), decreased plasma concentrations of syndecan-1 at the end of surgery (P = 0.049), more significantly decreased plasma concentrations of VCAM-1 at the end of surgery and 24 h after surgery (P < 0.001 and P = 0.017, respectively), and decreased plasma concentrations of IL-1β at the end of surgery and 24 h after surgery (P = 0.009 and 0.008, respectively). The C group showed increased plasma concentration of TNF-α at the end of surgery and 24 h after surgery compared with those before surgery (P = 0.003 and 0.023, respectively). Compared with the C group, the QoR-15 scores were higher at 24, 48, and 72 h after surgery (P = 0.001, 0.001, and 0.005, respectively) in the treatment group.ConclusionIntraoperative goal-directed fluid therapy in non-critically ill older patients may alleviate endothelial glycocalyx degradation with a lower incidence of adverse events.Clinical Trial Registrationhttp://www.chictr.org.cn/, Chinese Clinical Trial Registry ChiCTR2500097999.