Department of Anesthesiology and Intensive Care, Charles University teaching hospital, alej Svobody 80, Plzen 304 60, Czech Republic.
Crit Care. 2010;14(3):R118. doi: 10.1186/cc9070. Epub 2010 Jun 16.
Stroke volume variation (SVV) is a good and easily obtainable predictor of fluid responsiveness, which can be used to guide fluid therapy in mechanically ventilated patients. During major abdominal surgery, inappropriate fluid management may result in occult organ hypoperfusion or fluid overload in patients with compromised cardiovascular reserves and thus increase postoperative morbidity. The aim of our study was to evaluate the influence of SVV guided fluid optimization on organ functions and postoperative morbidity in high risk patients undergoing major abdominal surgery.
Patients undergoing elective intraabdominal surgery were randomly assigned to a Control group (n = 60) with routine intraoperative care and a Vigileo group (n = 60), where fluid management was guided by SVV (Vigileo/FloTrac system). The aim was to maintain the SVV below 10% using colloid boluses of 3 ml/kg. The laboratory parameters of organ hypoperfusion in perioperative period, the number of infectious and organ complications on day 30 after the operation, and the hospital and ICU length of stay and mortality were evaluated. The local ethics committee approved the study.
The patients in the Vigileo group received more colloid (1425 ml [1000-1500] vs. 1000 ml [540-1250]; P = 0.0028) intraoperatively and a lower number of hypotensive events were observed (2[1-2] Vigileo vs. 3.5[2-6] in Control; P = 0.0001). Lactate levels at the end of surgery were lower in Vigileo (1.78 +/- 0.83 mmol/l vs. 2.25 +/- 1.12 mmol/l; P = 0.0252). Fewer Vigileo patients developed complications (18 (30%) vs. 35 (58.3%) patients; P = 0.0033) and the overall number of complications was also reduced (34 vs. 77 complications in Vigileo and Control respectively; P = 0.0066). A difference in hospital length of stay was found only in per protocol analysis of patients receiving optimization (9 [8-12] vs. 10 [8-19] days; P = 0.0421). No difference in mortality (1 (1.7%) vs. 2 (3.3%); P = 1.0) and ICU length of stay (3 [2-5] vs. 3 [0.5-5]; P = 0.789) was found.
In this study, fluid optimization guided by SVV during major abdominal surgery is associated with better intraoperative hemodynamic stability, decrease in serum lactate at the end of surgery and lower incidence of postoperative organ complications.
Current Controlled Trials ISRCTN95085011.
每搏量变异度（SVV）是预测液体反应性的良好且易于获得的指标，可用于指导机械通气患者的液体治疗。在大型腹部手术中，不当的液体管理可能导致心血管储备能力受损的患者发生隐匿性器官低灌注或液体超负荷，从而增加术后发病率。我们的研究目的是评估 SVV 指导的液体优化对高危患者行大型腹部手术后器官功能和术后发病率的影响。
择期行腹腔内手术的患者被随机分配至对照组（n = 60），接受常规术中护理，和 Vigileo 组（n = 60），其中采用 SVV（Vigileo/FloTrac 系统）指导液体管理。目标是使用 3ml/kg 的胶体液使 SVV 保持在 10%以下。评估围手术期器官低灌注的实验室参数、术后第 30 天的感染和器官并发症数量、以及住院和 ICU 住院时间和死亡率。当地伦理委员会批准了该研究。
Vigileo 组患者术中接受了更多的胶体液（1425ml [1000-1500] vs. 1000ml [540-1250]；P = 0.0028），且观察到的低血压事件较少（2[1-2] Vigileo 组 vs. 3.5[2-6]对照组；P = 0.0001）。手术结束时，Vigileo 组的乳酸水平较低（1.78 +/- 0.83 mmol/L vs. 2.25 +/- 1.12 mmol/L；P = 0.0252）。Vigileo 组发生并发症的患者较少（18 名（30%）vs. 35 名（58.3%）患者；P = 0.0033），且总并发症数量也减少（Vigileo 组和对照组分别为 34 名和 77 名并发症；P = 0.0066）。仅在接受优化的患者的意向治疗分析中发现住院时间存在差异（9 [8-12] 天 vs. 10 [8-19] 天；P = 0.0421）。未发现死亡率（1 名（1.7%）vs. 2 名（3.3%）；P = 1.0）和 ICU 住院时间（3 [2-5] 天 vs. 3 [0.5-5] 天；P = 0.789）存在差异。
在这项研究中，大型腹部手术中由 SVV 指导的液体优化与术中血流动力学稳定性更好、手术结束时血清乳酸水平降低以及术后器官并发症发生率降低有关。
当前对照试验 ISRCTN95085011。
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