Fluid resuscitation with guidance of pulse pressure variability measured by continuous non-invasive arterial pressure monitor in postoperative hypovolemic patients: a prospective randomized controlled trial

Yimin XUE; Tingfeng HUANG; Meiqi CHEN; Qiaolian FAN; Fenghui LIN; Feng CHEN

doi:10.16016/j.2097-0927.202107084

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Fluid resuscitation with guidance of pulse pressure variability measured by continuous non-invasive arterial pressure monitor in postoperative hypovolemic patients: a prospective randomized controlled trial

Clinical Medicine | 更新时间：2026-01-09

- Fluid resuscitation with guidance of pulse pressure variability measured by continuous non-invasive arterial pressure monitor in postoperative hypovolemic patients: a prospective randomized controlled trial
- Journal of Army Medical University Vol. 44, Issue 6, Pages: 595-600(2022)
- 作者机构：
  
  1.350001 福州，福建医科大学省立临床医学院，福建省立医院: 重症医学四科
  2.350001 福州，福建医科大学省立临床医学院，福建省立医院: 急诊科，福建省急诊医学重点实验室
- 作者简介：
- 基金信息：
  
  the Construction Project for Critical Care Medical Center of Fujian Province(2017-510);the Youth Scientific Research Project of Fujian Provincial Health Commission(2019-2-1)
- DOI：10.16016/j.2097-0927.202107084
  CLC： R443.5; R654.1
- Received：13 July 2021，
  
  Revised：2021-09-15，
  
  Published：30 March 2022
- 稿件说明：
移动端阅览
Yimin XUE, Tingfeng HUANG, Meiqi CHEN, et al. Fluid resuscitation with guidance of pulse pressure variability measured by continuous non-invasive arterial pressure monitor in postoperative hypovolemic patients: a prospective randomized controlled trial[J]. Journal of Army Medical University, 2022, 44(6): 595-600.
DOI：

Yimin XUE, Tingfeng HUANG, Meiqi CHEN, et al. Fluid resuscitation with guidance of pulse pressure variability measured by continuous non-invasive arterial pressure monitor in postoperative hypovolemic patients: a prospective randomized controlled trial[J]. Journal of Army Medical University, 2022, 44(6): 595-600. DOI： 10.16016/j.2097-0927.202107084.

摘要

目的

探讨每搏连续无创血压监测系统(continuous non-invasive arterial pressure monitor

CNAP)监测的脉压变异度(pulse pressure variability

PPV)在指导外科术后患者液体复苏中的作用。

方法

采用随机对照研究方案，选择2018年8月至2020年8月福建省立医院重症医学科收治的外科术后低血容量患者，按照随机数字表法分为PPV组和中心静脉压(central venous pressure

CVP)组，分别以CNAP监测PPV(

10%)和CVP(8~12 mmHg)为目标导向来指导液体复苏。主要观察指标为复苏达标时间、机械通气时间、复苏达标累计液体平衡量及心肺并发症发生率；次要观察指标为复苏达标时的血流动力学指标[心率(heart rate

HR)、平均动脉压(mean arterial pressure

MAP)、CVP、心排血指数(cardiac index

CI)、PPV

]

和组织氧代谢指标[中心静脉血氧饱和度(central venous oxygen saturation

ScvO

)、动脉血乳酸(lactic acid

Lac)、氧供指数(oxygen delivery index

I)、氧耗指数(oxygen consumption index

I)、氧摄取率(oxygen uptake rate

ERO

)

]

。

结果

共纳入78例患者，其中PPV组38例CVP组40例。两组患者入组时的一般临床资料、血流动力学和组织氧代谢指标无统计学差异。复苏后，两组患者的血流动力学及组织氧代谢指标均有所改善，MAP、CI及PPV无统计学差异，但PPV组的CVP明显低于CVP组(

0.05)。PPV组的ScvO

、DO

I、VO

I及ERO

均明显高于CVP组(

0.05)，且Lac明显低于CVP组(

0.05)。PPV组的复苏达标时间及机械通气时间明显缩短，累计液体平衡量明显减少，心肺并发症发生率明显降低(

0.05)。

结论

每搏连续无创血压监测系统监测脉压变异度可以指导术后低血容量患者的早期液体复苏，有助于尽快稳定血流动力学状态，改善机体组织灌注，缩短机械通气时间，减少心肺并发症的发生风险。

Abstract

Objective

To investigate the effectiveness of pulse pressure variability (PPV) measured by continuous non-invasive arterial pressure (CNAP) monitor in guidance of fluid resuscitation in postoperative hypovolemic patients.

Methods

A prospective randomized controlled trial was conducted on the postoperative hypovolemic patients admitted to Department of Intensive Care Unit of Fujian Provincial Hospital from August 2018 to August 2020. They were randomly divided into PPV group and central venous pressure (CVP) group

and fluid resuscitation targeted by PPV

10% (measured by CNAP) and CVP 8~12 mmHg were performed respectively. The main outcomes included fluid resuscitation time

duration of mechanical ventilation

cumulative fluid balance and incide

nce of cardiopulmonary complications. The secondary outcomes included hemodynamics [heart rate (HR)

mean arterial pressure (MAP)

CVP

cardiac index (CI)

and PPV

]

and tissue oxygen metabolism [central venous oxygen saturation (ScvO

)

arterial lactic acid (Lac)

oxygen delivery index (DO

oxygen consumption index (VO

and oxygen uptake rate (ERO

)

]

as the goal of fluid resuscitation was arrived.

Results

A total of 78 patients were enrolled

including 38 in PPV group and 40 in CVP group. There were no significant differences in the baseline

hemodynamic and tissue oxygen metabolism parameters between the 2 groups (all

0.05). The hemodynamic and tissue oxygen metabolism parameters were significantly improved as the goal of fluid resuscitation was arrived. No significant differences were seen in MAP

CI and PPV between the 2 groups after fluid resuscitation (all

0.05)

while CVP in the PPV group was significantly lower than that of the CVP group (

0.05). Compared with the CVP group

the ScvO

I and ERO

were increased significantly after fluid resuscitation in the PPV group (all

0.05)

while Lac was decreased obviously in the PPV group (

0.05). Furthermore

the fluid resuscitation time and duration of mechanical ventilation were notably shortened

the cumulative fluid balance was remarkably decreased

and the incidence of cardiopulmonary complications was statistically reduced in the PPV group than the CVP group (all

0.05).

Conclusion

PPV measured by CNAP monitor can be used to guide the early fluid resuscitation in postoperative hypovolemic patients

which contributes to stabilizing the hemodynamic state more timely

improving the tissue oxygen metabolism

shortening the duration of mechanical ventilation

and reducing the risk of cardiopulmonary complications.

关键词

Keywords

references

KALKWARF K J, COTTON B A. Resuscitation for hypovolemic shock[J]. Surg Clin North Am, 2017, 97(6): 1307-1321. DOI: 10.1016/j.suc.2017.07.011.

FINFER S, BELLOMO R, BOYCE N, et al . A comparison of albumin and saline for fluid resuscitation in the intensive care unit[J ] . N Engl J Med, 2004, 350(22): 2247-2256. DOI: 10.1056/NEJMoa040232.

LOU X, LU G, ZHAO M, et al . Preoperative fluid management in traumatic shock: A retrospective study for identifying optimal therapy of fluid resuscitation for aged patients[J ] . Medicine (Baltimore), 2018, 97(8): e9966. DOI: 10.1097/MD.0000000000009966.

ROGGE D E, NICKLAS J Y, HAAS S A, et al . Continuous noninvasive arterial pressure monitoring using the vascular unloading technique (CNAP system) in obese patients during laparoscopic bariatric operations[J ] . Anesth Analg, 2018, 126 (2): 454-463. DOI: 10.1213/ANE.000000000000 2660.

RATHORE A, SINGH S, LAMSAL R, et al . Validity of pulse pressure variation (PPV) compared with stroke volume variation (SVV) in predicting fluid responsiveness[J ] . Turk J Anaesthesiol Reanim, 2017, 45(4): 210-217. DOI: 10.5152/TJAR.2017.04568.

中华医学会重症医学分会. 低血容量休克复苏指南(2007)[J]. 中国危重病急救医学, 2008, 20(3): 129-134.

Branch of Critical Care Medicine of Chinese Medical Association. Guidelines for resuscitation of hypovolemic shock (2007)[J]. Chin Crit Care Med, 2008, 20(3): 129-134.

PRÉAU S, SAULNIER F, DEWAVRIN F, et al . Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis[J ] . Crit Care Med, 2010, 38(3): 819-825. DOI: 10.1097/CCM.0b013e3181c8fe7a.

MALBOUISSON L M S, SILVA JM J R, CARMONA M J C, et al . A pragmatic multi-center trial of goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery[J ] . BMC Anesthesiol, 2017, 17(1): 70. DOI: 10.1186/s12871-017-0356-9.

SUN Y, LU Z H, ZHANG X S, et al . The effects of fluid resuscitation according to PiCCO on the early stage of severe acute pancreatitis[J ] . Pancreatology, 2015, 15(5): 497-502. DOI: 10.1016/j.pan.2015.06.006.

RENNER J, GRUENEWALD M, HILL M, et al . Non-invasive assessment of fluid responsiveness using CNAPTM technology is interchangeable with invasive arterial measurements during major open abdominal surgery[J ] . Br J Anaesth, 2017, 118(1): 58-67. DOI: 10.1093/bja/aew399.

BIAIS M, STECKEN L, MARTIN A, et al . Continuous and non-invasive assessment of pulse pressure variations using CNAP® system[J ] . J Clin Monit Comput, 2017, 31(4): 685-692. DOI: 10.1007/s10877-016-9899-4.

薛贻敏, 吴畏, 陈明光, 等. 每搏连续无创血压监测系统评估机械通气重症患者血流动力学状态的临床研究[J]. 中华危重病急救医学, 2019, 31(10): 1231-1235. DOI: 10.3760/cma.j.issn.2095-4352.2019.10.010.

XUE Y M, WU W, CHEN M G, et al . A clinical study of the evaluation of hemodynamic status in mechanically ventilated critically ill patients by continuous non-invasive arterial pressure monitor[J ] . Chin Crit Care Med, 2019, 31(10): 1231-1235. DOI: 10.3760/cma.j.issn.2095-4352.2019.10.010.

BOU CHEBL R, EL KHURI C, S HAMI A, et al . Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study[J ] . Scand J Trauma Resusc Emerg Med, 2017, 25(1): 69. DOI: 10.1186/s13049-017-0415-8.

YI X L, WANG J T, CHU C Q, et al . Cardiocerebral protective effects of dexmedetomidine as anesthetic in colorectal cancer surgery[J ] . Eur Rev Med Pharmacol Sci, 2018, 22(11): 3570-3576. DOI: 10.26355/eurrev_201806_15183.

HASANIN A, ZANATA T, OSMAN S, et al . Pulse pressure variation-guided fluid therapy during supratentorial brain tumour excision: a randomized controlled trial[J ] . Open Access Maced J Med Sci, 2019, 7(15): 2474-2479. DOI: 10.3889/oamjms.2019.682.

罗南博, 赵昭, 项明方, 等. 脉搏压变异度指导肺部分切除术液体管理的随机对照分析[J]. 临床外科杂志, 2017, 25(12): 942-945. DOI: 10.3969/j.issn.1005-6483.2017.12.020.

LUO N B, ZHAO Z, XIANG M F, et al . Pulse pressure variation guided-fluid management in thoracoscopic pneumectomy: a randomized controlled trial[J ] . J Clin Surg, 2017, 25(12): 942-945. DOI: 10.3969/j.issn.1005-6483.2017.12.020.

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