Stroke volume variation-based volume management in anesthesia management in surgeries for malignant obstructive jaundice: a randomized controlled trial

Jian HUANG; Zhen YANG; Xian GAO; Yuan ZHU; Kaizhi LU; Jiaolin NING

doi:10.16016/j.1000-5404.201801033

您当前的位置：

首页 >

文章列表页 >

Stroke volume variation-based volume management in anesthesia management in surgeries for malignant obstructive jaundice: a randomized controlled trial

Clinical Medicine | 更新时间：2026-01-09

- Stroke volume variation-based volume management in anesthesia management in surgeries for malignant obstructive jaundice: a randomized controlled trial
- Journal of Third Military Medical University Vol. 40, Issue 10, Pages: 918-922, 933(2018)
- 作者机构：
  
  40038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
- 基金信息：
  
  the Military Medical Innovation Plan of the First Affiliated Hospital of Army Medical University(SWH2017JSZD-02)
- DOI：10.16016/j.1000-5404.201801033
  CLC： R331.31;R614;R657.43
- Received：04 January 2018，
  
  Revised：2018-02-01，
  
  Published：30 May 2018
- 稿件说明：
移动端阅览
Jian HUANG, Zhen YANG, Xian GAO, et al. Stroke volume variation-based volume management in anesthesia management in surgeries for malignant obstructive jaundice: a randomized controlled trial[J]. Journal of Third Military Medical University, 2018, 40(10): 918-922, 933.
DOI：

Jian HUANG, Zhen YANG, Xian GAO, et al. Stroke volume variation-based volume management in anesthesia management in surgeries for malignant obstructive jaundice: a randomized controlled trial[J]. Journal of Third Military Medical University, 2018, 40(10): 918-922, 933. DOI： 10.16016/j.1000-5404.201801033.

摘要

目的

探讨基于每搏量变异(stroke volume variance，SVV)为导向的容量管理策略对梗阻性黄疸患者围术期麻醉管理临床应用价值。

方法

纳入2015年11月至2017年3月我院肝胆外科接受手术治疗的恶性梗阻性黄疸患者50例，其中男性41例，女性9例，年龄(53.3±8.5)岁，体质量(59.8±9.0)kg，随机分为对照组和SVV组(

=25)。两组患者采用相同的麻醉诱导与维持方式。对照组根据有创血压、中心静脉压(central venous pressure，CVP)和麻醉医师的经验进行液体输注和血管活性药物使用；SVV组根据FloTrac/Vigileo分析得到的SVV值指导液体输注和血管药物的使用，维持SVV在13%以下。对比分析两组患者术中血流动力学指标、血气分析指标、术中液体及血管活性药物的使用情况、术后肾脏功能、PACU及ICU停留时间。

结果

SVV组患者术中血压稳定，手术结束时乳酸水平无明显增高[（2.48±0.26）mmol/L

（1.48±0.89）mmol/L，

0.05

]

；氧合指数显著高于对照组，氧合异常发生率显著低于对照组（20%

52%，

0.05）；术中晶体液的使用量显著少于对照组[（1 150±235）mL

（1 981±808）mL，

0.01

]

，去甲肾上

腺素的使用率高于对照组（72%

44%，

0.05），多巴酚丁胺的使用率高于对照组（

=25，36%

8%，

0.05），ICU停留时间显著低于对照组[（1.18±0.63）d

（3.38±1.36）d，

0.01

]

，肾功能异常发生率组间比较差异无统计学意义（

0.05）。

结论

SVV的容量管理策略能优化梗阻性黄疸患者术中循环状态，减少容量过负荷和血管活性药物滥用的潜在危害，改善微循环灌注，降低呼吸系统并发症的发生率及ICU停留时间。

Abstract

Objective

To evaluate the clinical effectiveness of stroke volume variation (SVV)-based strategy of volume management in patients undergoing surgeries for malignant obstructive jaundice.

Methods

Fifty patients with malignant obstructive jaundice (including 41 male and 9 female patients

mean age 53.3±8.5 years

mean body mass 59.8±9.0 kg) undergoing surgeries in our hospital between November

2015 and March

2017 were enrolled in this trial. A computer-generated randomization sequence (at a 1:1 ratio) was used to randomly assign patients into control group and SVV group (

=25). All the patients received induction and maintenance anesthesia following the same protocols. The patients in the control group were given perioperative fluid replacement and vasoactive drugs according to the invasive artery pressure

central venous pressure (CVP) and the experience of anesthesiologists. In SVV group

a target SVV below 13% was maintained and the fluid volume and use of vasoactive drugs were adjusted according to the perioperative SVV value. The intraoperative hemodynamic indexes

blood gas analysis indexes

intraoperative fluid volume

dose of vasoactive drugs used

postoperative renal function

PACU and ICU stay time were compared between the 2 groups.

Results

Compared with those in the control group

the patients in SVV group showed a more stable intraoperative blood pressure without significantly increased lactic acid level

at the end of the operation (2.48±0.26

1.48±0.89 mmol/L

0.05). The PaO

/FiO

ratio was significantly higher in SVV group

and the incidence of oxygenation abnormalities was significantly lower in SVV group than in the control group (20%

52%

0.05). Compared with the control group

the SVV group had a significantly less intraoperative fluid volume (1 981±808

1 150±235 mL

0.05) and higher rates of norepinephrine use (44%

72%

0.05) and dobutamine use (

=25

36%

0.05). The duration of ICU stay was significantly shorter in SVV group than in the control group (1.18±0.63

3.38±1.36 d

0.01). The incidence of renal dysfunction was not significantly different between the 2 groups (

0.05).

Conclusion

In patients undergoing surgeries for malignant obstructive jaundice

SVV-based fluid management can optimize the hemodynamic status and thus helps to reduce the incidence of respiratory and renal dysfunction and shorten the duration of ICU stay to improve the patients' prognosis.

关键词

Keywords

references

KUNJAM M. Clinical approach to patients with obstructive jaundice[J]. Tech Vasc Interv Radiol, 2015, 18(4): 197-200. DOI: 10.1053/j.tvir.2015.07.002.

FANG Y, GURUSAMY KS, WANG Q, et al . Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice[J ] . Br J Surg, 2013, 100(12): 1589-1596. DOI: 10.1002/bjs.9260.

MOOLE H, BECHTOLD M, PULI S R.Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review[J].World J Surg Oncol, 2016, 14(1): 182. DOI: 10.1186/s12957-016-0933-2.

XU J Y, CHEN Q H, LIU S Q, et al . The effect of early goal-directed therapy on outcome in adult severe sepsis and septic shock patients: a meta-analysis of randomized clinical trials[J ] .Anesth Analg, 2016, 123(2): 371-381. DOI: 10.1213/ANE.0000000000001278.

LEE J, KIM W H, RYU H G, et al . Stroke volume variation-guided versus central venous pressure-guided low central venous pressure with milrinone dur ing living donor hepatectomy: a randomized double-blinded clinical trial[J ] .Anesth Analg, 2017, 125(2): 423-430. DOI: 10.1213/ANE.0000000000002197.

ZHANG J, CHEN C Q, LEI X Z, et al . Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study[J ] .Clinics (Sao Paulo), 2013, 68(7): 1065-1070. DOI: 10.6061/clinics/2013(07)27.

廖志敏.Flo Trac/Vigileo系统的临床应用进展[J].西部医学, 2017, 29 (2): 284-287. DOI: 10.3969/j.issn.1672-3511.2017.02.034.

LIAO Z M. Progress in clinical application of Flo Trac/Vigileo system[J].Med J West China, 2017, 29 (2): 284-287. DOI: 10.3969/j.issn.1672-3511.2017.02.034.

刘新锋, 潘家华, 刘红明.FloTrac/Vigileo心排量监测仪在心功能不全患者中的应用[J].中国现代医生, 2012, 50 (31): 103-104.

LIU X F, PAN J H, LIU H M. Clinical study of using FloTrac/Vigileo monitor in patients with cardiac dysfunction[J]. China Modern Doctor, 2012, 50(31): 103-104.

孙振涛, 王宁, 孙雪青, 等.基于FloTrac/Vigileo监测不同PEEP值对患者心指数、每搏变异度及氧输送指数的影响[J].天津医药, 2017, 45 (3): 294-296. DOI: 10.11958/20160785.

SUN Z T, WANG N, SUN X Q, et al . The effects of different values of PEEP on heart index, stroke volume variation and oxygen transport index in patients monitored by FloTrac/Vigileo system[J ] . Tianjin Med J, 2017, 45 (3): 294-296. DOI: 10.11958/20160785.

WANG L, YU W F.Obstructive jaundice and perioperative management[J]. Acta Anaesthesiol Taiwan, 2014, 52(1): 22-29. DOI: 10.1016/j.aat.2014.03.002.

KOBAYASHI M, KOH M, IRINODA T, et al . Stroke volume variation as a predictor of intravascular volume depression andpossible hypotension during the early postoperative period after esophagectomy[J ] . Ann Surgoncol, 2009, 16(5): 1371-1377. DOI: 10.1245/s10434-008-0139-0.

孟改革, 方卫平, 张雷, 等.目标导向液体治疗下晶体液与胶体液输注对肝切除术患者组织灌注和术后恢复的影响[J].临床麻醉学杂志, 2017, 33(6): 557-561

MENG G G, FANG W P, ZHANG L, et al .Effects of goal-directed fluid therapy filled with crystalliods or colliods on the recovery of tissue perfusion and postoperative recovery in patients undergoing hepatectomy[J ] .J Clin Anesth, 2017, 33 (6): 557-561.

PEARSE R M, HARRISON D A, MACDONALD N, et al . Effect of a perioperative cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review [J ] . JAMA, 2014, 311(21): 2181-2190. DOI: 10.1001/jama.2014.5305.

STENS J, OEBEN J, VAN DUSSELDORP A A, et al .Non-invasive measurements of pulse pressure variation and stroke volume variation in anesthetized patients using the Nexfin blood pressure monitor[J ] . J Clin Monit Comput, 2016, 30(5): 587-594. DOI: 10.1007/s10877-015-9759-7.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Influencing factors for perioperative diarrhea in recipients after deceaseddonor kidney transplant

Perioperative anesthesia management for pregnant patients with pulmonary arterial hypertension

Exogenous carbon monoxide improves postoperative anxiety-like behaviors in elderly rats by inhibiting excessive autophagy of astrocytes

Protective effect of methylene blue on postoperative liver and kidney functions in patients with obstructive jaundice

Perioperative changes of plasma circulating cell-free DNA in patients with coronary artery bypass graft and double valve replacement under cardiopulmonary bypass

Related Author

牛玉林

潘光辉

徐媛

晁晟

贾磊

杨麒臻

袁智辉

文静

Related Institution

No data

⁰