Efficacy of stroke volume variation combined with low central venous pressure-directed fluid therapy in patients undergoing liver cancer resection / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the efficacy of stroke volume variation (SVV) combined with controlled low central venous pressure (CLCVP)-directed fluid therapy in the patients undergoing liver cancer resection.Methods Seventy American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 40-60 yr,with body mass index of 20-25 kg/m2,scheduled for elective liver cancer resection under general anesthesia,were divided into 2 groups (n=35 each) using a random number tableroutine fluid replacement group (R group) and SVV combined with CLCVP-guided fluid replacement group (SC group).In R group,routine fluid replacement included compensatory volume expansion,physiological requirement,cumulative loss,continued loss (intraoperative blood loss) and 3rd space losses,maintaining mean arterial pressure＞70 mmHg,central venous pressure＜4 cmH2O and heart rate ＜ 100 bpm.Central venous pressure was maintained ＜4 cmH2O and SVV ＜ 12％ during operation in SC group.The operation time,total amount of crystalloid and colloid solution infused,urine volume and development of intraoperative hypotension and bradycardia were recorded.Blood samples from the left radial artery and central vein were collected before anesthesia induction and at the end of operation for measurement of the blood lactate concentration,and the oxygen supply index,oxygen consumption index and oxygen uptake rate were calculated.Blood samples from the ulnar vein were collected before anesthesia induction and at the end of operation for determination of serum β2-microglobulin concentrations.The development of intraoperative adverse cardiovascular events was recorded,and the occurrence of postoperative complications was observed.Results Compared with R group,the total amount of crystalloid solution infused was significantly decreased,the total amount of colloid solution infused and urine volume were increased,the incidence of intraoperative hypotension and bradycardia was decreased,oxygen supply index,oxygen consumption index and oxygen uptake rate were increased at the end of operation,and the lactate concentration in arterial blood,serum β2-microglobulin concentration and rate of postoperative pulmonary infection were decreased in SC group (P＜0.05).Conclusion SVV combined with CLCVP-directed fluid therapy produces better efficacy than routine fluid replacement in the patients undergoing liver resection.