Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
J Clin Monit Comput. 2013 Jun;27(3):225-33. doi: 10.1007/s10877-013-9461-6. Epub 2013 Apr 5.
Perioperative hemodynamic optimisation improves postoperative outcome for patients undergoing high-risk surgery (HRS). In this prospective randomized multicentre study we studied the effects of an individualized, goal-directed fluid management based on continuous stroke volume variation (SVV) and stroke volume (SV) monitoring on postoperative outcomes. 64 patients undergoing HRS were randomized either to a control group (CON, n = 32) or a goal-directed group (GDT, n = 32). In GDT, SVV and SV were continuously monitored (FloTrac/Vigileo) and patients were brought to and maintained on the plateau of the Frank-Starling curve (SVV <10 % and SV increase <10 % in response to fluid loading). Organ dysfunction was assessed using the SOFA score and resource utilization using the TISS score. Patients were followed up to 28 days for postoperative complications. Main outcome measures were the number of complications (infectious, cardiac, respiratory, renal, hematologic and abdominal post-operative complications), maximum SOFA score and cumulative TISS score during ICU stay, duration of mechanical ventilation, length of ICU stay, and time until fit for discharge. 12 patients had to be excluded from final analysis (6 in each group). During surgery, GDT received more colloids than CON (1,589 vs. 927 ml, P < 0.05) and SVV decreased in GDT (from 9.0 to 8.0 %, P < 0.05) but not in CON. The number of postoperative wound infections was lower in GDT (0 vs. 7, P < 0.01). Although not statistically significant, the proportion of patients with at least one complication (46 vs. 62 %), the number of postoperative complications per patient (0.65 vs. 1.40), the maximum sofa score (5.9 vs. 7.2), and the cumulative TISS score (69 vs. 83) tended to be lower. This multicentre study shows that fluid management based on a SVV and SV optimisation protocol is feasible and decreases postoperative wound infections. Our findings also suggest that a goal-directed strategy might decrease postoperative organ dysfunction.
围手术期血流动力学优化可改善高危手术（HRS）患者的术后转归。在这项前瞻性随机多中心研究中，我们研究了基于连续每搏量变异（SVV）和每搏量（SV）监测的个体化、目标导向的液体管理对术后转归的影响。64 例接受 HRS 的患者随机分为对照组（CON，n=32）或目标导向组（GDT，n=32）。在 GDT 中，连续监测 SVV 和 SV（FloTrac/Vigileo），并使患者达到并维持在 Frank-Starling 曲线的平台（SVV<10%，SV 增加<10%以应对液体负荷）。器官功能障碍使用 SOFA 评分评估，资源利用使用 TISS 评分评估。患者在术后 28 天内进行随访，以评估术后并发症。主要观察指标为并发症数量（感染、心脏、呼吸、肾脏、血液和腹部术后并发症）、ICU 期间最大 SOFA 评分和累积 TISS 评分、机械通气时间、ICU 住院时间和适合出院时间。最终分析排除了 12 例患者（每组 6 例）。在手术期间，GDT 接受的胶体比 CON 多（1589 比 927ml，P<0.05），并且 GDT 的 SVV 降低（从 9.0%降至 8.0%，P<0.05），但 CON 没有。GDT 组术后伤口感染的数量较低（0 比 7，P<0.01）。尽管没有统计学意义，但至少有 1 种并发症的患者比例（46%比 62%）、每位患者的术后并发症数量（0.65 比 1.40）、最大 SOFA 评分（5.9 比 7.2）和累积 TISS 评分（69 比 83）均倾向于降低。这项多中心研究表明，基于 SVV 和 SV 优化方案的液体管理是可行的，可减少术后伤口感染。我们的研究结果还表明，目标导向策略可能会降低术后器官功能障碍。
