Effects of Goal-Directed Fluid Therapy on Postoperative Delirium in Elderly Hip Fracture Patients

Abstract

Objective: To analyze the effects of goal-directed fluid therapy on postoperative cerebral oxygen metabolism level (rScO₂), blood pressure (MAP), heart rate (HR), and incidence of intraoperative hypotension and delirium in elderly hip fracture patients. Methods: Sixty-six elderly patients who underwent hip fracture surgery under intrathecal anesthesia in a hospital between October 2023 and September 2024 were selected and divided into a control group and an observation group using the mean score method, each with 33 cases. Both groups were given dexmedetomidine 10 min before surgery, and the control group was treated with conventional intraoperative fluid replacement, while the observation group was treated with goal-directed fluid therapy. The rScO₂, MAP, HR, the incidence of intraoperative hypotension, and the index of delirium MMSE score at preoperative (T₀), subarachnoid block for 5 min (T₁), and surgical 30 min (T₂) were observed and compared between the two groups. Results: The difference between the left rScO₂ and right rScO₂ levels at T₀ between the two groups was not significant (P > 0.05), but the left rScO₂ and right rScO₂ levels were significantly higher in the observation group than in the control group at T₁ and T₂ (P < 0.05); compared with the group at T₀, the patients in the control group at T₁, left rScO₂ and right rScO₂ levels were significantly lower at T₂ (P < 0.05); the left rScO₂ and right rScO₂ levels at T₁ and T₂ of patients in the observation group were higher than those at T₀, and the difference was not statistically significant (P > 0.05). There was no statistically significant difference in the levels of MAP and HR at T₀ between the two groups (P > 0.05), and the levels of MAP and HR at T₁ and T₂ were significantly higher in the observation group than those of the control group (P < 0.05); compared with the group’s levels at T₀, there was a significant decrease in the levels of MAP and HR in the control group at T₁ and T₂, with the difference being statistically significant (P < 0.05); HR at T₁ was significantly lower than that at T₀ in patients in the observation group (P < 0.05); however, the difference between MAP at T₁ and T₂ and HR at T₂ compared with that at T₀ was not statistically significant (P > 0.05); the incidence of intraoperative hypotension in the observation group (3.03%) was significantly lower than that of the control group (24.24%) (P < 0.05). There was no statistically significant difference in MMSE scale scores between the two groups of patients in the preoperative 1d (P > 0.05); compared with the preoperative 1d in the group, there was a significant decrease in MMSE scale scores in the postoperative 1d and 3d in the two groups, with the observation group being significantly higher than the control group (P > 0.05); the difference between MMSE scale scores in the postoperative 1d and 3d in the control group and those of the preoperative 1d in the control group had statistical significance (P < 0.05); the difference between the postoperative 1d and 3d MMSE scale scores of the observation group and the preoperative 1d was not statistically significant (P > 0.05). Conclusion: During the implementation of intrathecal anesthesia for hip fracture surgery in the elderly, the application of goal-directed fluid therapy can improve the oxygen metabolism of cerebral tissues, reduce the fluctuation of intraoperative blood pressure and heart rate, lower the incidence of postoperative hypotension, and help to promote the recovery of patients’ postoperative cognitive functions.