Effects of Goal-Directed Fluid Therapy on MAP, NTproBNP, and hs-CRP in Elderly Patients with Lower Extremity Fractures Undergoing Open Reduction and Internal Fixation

Abstract

Objective: To investigate the effects of goal-directed fluid therapy on mean arterial pressure (MAP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP) levels in elderly patients with lower limb fracture undergoing open reduction and internal fixation surgery 24 hours after surgery. Methods: Sixty elderly patients admitted to our hospital from June 2022 to February 2023 for open reduction and internal fixation of lower limb fractures were randomly divided into two groups: 30 cases in the observation group and 30 cases in the control group. The patients in the control group were treated with conventional fluid therapy, and the observation group received goal-directed fluid therapy on the basis of the control group. The patients in the two groups were observed to monitor the changes of mean arterial pressure (MAP) and heart rate (HR), as well as the preoperative and 24-hour postoperative levels of NT-proBNP and hs-CRP. Results: The NT-proBNP level in the control group was 608.37 ± 180.46 ng/ml and the hs-CRP level was 510.09 ± 190.21 pg/ml during the operation, and the NT-proBNP and hs-CRP levels in the observation group were 608.74 ± 180.26 ng/ml and 514.12 ± 180.63 pg/ml, respectively, and the difference between the two groups was not statistically significant (P > 0.05). The levels of NT-proBNP and hs-CRP in the control group were 369.74 ± 77.11 ng/ml and 298.41 ± 72.14 pg/ml respectively at 24-hour postoperatively, and those in the observation group were 324.74 ± 71.26 ng/ml and 245.12 ± 77.63 pg/ml, the difference between the two groups was statistically significant (P < 0.05). In the control group, the preoperative MAP and heart rate were 14.12 ± 3.92 mmHg and 47.18 ± 15.42 beats/min respectively; in the intraoperative period, the MAP and heart rate were 54.81 ± 14.41 mmHg and 60.65 ± 14.11 beats/min. In the observation group, the preoperative MAP and heart rate were 15.12 ± 3.48 mmHg and 48.21 ± 15.36 beats/min, and the intraoperative MAP and heart rate were 50.16 ± 14.03 mmHg and 57.65 ± 14.10 beats/min, the difference was statistically significant (P < 0.05). Conclusion: Compared with traditional fluid therapy, goal-directed fluid therapy can reduce MAP, NT-proBNP, and hs-CRP levels in elderly patients with lower limb fractures undergoing open reduction and internal fixation surgery, and reduce the incidence of postoperative complications.