Kobayashi Makoto, Koh Masayoshi, Irinoda Takashi, Meguro Eiji, Hayakawa Yoshiro, Takagane Akinori
Surgical Division, Hakodate Goryoukaku Hospital, Hakodate City, Hokkaido, Japan.
Ann Surg Oncol. 2009 May;16(5):1371-7. doi: 10.1245/s10434-008-0139-0. Epub 2009 Feb 14.
Perioperative hypotension during esophagectomy results from hypovolemia caused by a shift of extracellular fluid from the intravascular to the extravascular compartment. Fluid management is often difficult to gauge during major surgery because there are no reliable indicators of fluid status, and some patients still experience cardiorespiratory instability. In this retrospective study, we evaluated stroke volume variation (SVV), calculated by using a new arterial pressure-based cardiac output measurement device, as a predictor for fluid responsiveness after esophageal surgery.
Eighteen patients undergoing esophagectomy with extended radical lymphadenectomy were monitored by the FloTrac sensor/Vigileo monitor system during the perioperative and immediate postoperative period. Fluid responsiveness was assessed and compared with concurrent SVV and central venous pressure (CVP) values, and routine hemodynamic variables.
Eleven of 18 patients needed additional volume loading within the first 10 postoperative hours as a result of hypotension. The maximum SVV value of fluid resuscitated patients was >15% in all cases, whereas six of seven patients without postoperative hypotension had maximum SVV values of <15%. The correlation between SVV and the development of hypotension was statistically significant (P = 0.0012). From the linear correlation analysis of hemodynamic variables influenced by additional fluid loading, SVV was significantly correlated to cardiac output (r = 0.638; P = 0.049), whereas CVP was not (P > 0.05).
We conclude that SVV, as displayed on the Vigileo monitor, is an accurate predictor of intravascular hypovolemia and is a useful indicator for assessing the appropriateness and timing of applying fluid for improving circulatory stability during the perioperative period after esophagectomy.
食管癌切除术中围手术期低血压是由细胞外液从血管内转移至血管外间隙导致的血容量不足引起的。在大型手术中，液体管理往往难以把握，因为没有可靠的液体状态指标，而且一些患者仍会出现心肺不稳定的情况。在这项回顾性研究中，我们评估了通过一种基于动脉压的新型心输出量测量设备计算得出的每搏量变异（SVV），作为食管手术后液体反应性的预测指标。
18例行食管癌根治性扩大淋巴结清扫术的患者在围手术期及术后即刻由FloTrac传感器/Vigileo监测系统进行监测。评估液体反应性，并与同期的SVV、中心静脉压（CVP）值以及常规血流动力学变量进行比较。
18例患者中有11例在术后10小时内需因低血压进行额外的容量负荷。所有液体复苏患者的最大SVV值均>15%，而7例无术后低血压的患者中有6例最大SVV值<15%。SVV与低血压发生之间的相关性具有统计学意义（P = 0.0012）。从额外液体负荷影响的血流动力学变量的线性相关分析来看，SVV与心输出量显著相关（r = 0.638；P = 0.049）,而CVP则不然（P > 0.05）。
我们得出结论，Vigileo监测仪上显示的SVV是血管内血容量不足的准确预测指标，并且是评估食管癌切除术后围手术期应用液体以改善循环稳定性的适宜性和时机的有用指标。
