Shah Shagun Bhatia, Bhargava Ajay Kumar, Hariharan Uma, Jain Chamound Rai, Kulkarni Anita, Gupta Namrata
Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, Delhi, India.
Dr. Ram Manohar Lohia Hospital and PGIMER, CHS, New Delhi, India.
Saudi J Anaesth. 2020 Jan-Mar;14(1):7-14. doi: 10.4103/sja.SJA_215_19. Epub 2020 Jan 6.
This study aims to trans oesophageal echo cardiographically (TOE) measure inferior venacava diameter (IVCD) during inspiration and expiration in poor left ventricular ejection fraction (LVEF) patients undergoing cytoreductive oncosurgery, to ascertain if any correlation exists between, caval index (DeltaIVCD), and stroke volume variation (SVV), and to compare DeltaIVCD-guided versus SVV-guided fluid therapy.
In this prospective, parallel group, interventional study, seventy American Society of Anesthesiologists-III patients, aged 30-75 years, weighing 40-90 kg, with LVEF ≤40% undergoing cytoreductive surgery were included and randomised to group-D (DeltaIVCD-guided fluid therapy) and group-S (SVV-guided fluid therapy). Patients with oesophageal lesions were excluded. After standard endotracheal anaesthesia, arterial and internal jugular vein catheters were placed. A TOE probe was inserted in the interventional group-D. Quantification of IVCD respiratory variations was done. Heart rate (HR), arterial oxygen saturation (SPO), mean arterial pressure, end tidal carbondioxide (EtCO), central venous pressure, SVV, IVCD, and urine output (UO) were recorded every 30 min. Post-operative arterial blood gas analysis, lung-ultrasound, chest-radiograph, and serum creatinine were done.
Pearson's correlation coefficient as measure of strength of linear relationship, calculation of regression equation, and unpaired -test for normally distributed continuous variables were used.
A positive correlation between DeltaIVCD and SVV (r = 0.751) was observed. A regression equation was obtained for SVV (SVV = [0.317 × DeltaIVCD] + 5.877). Serum lactate, estimated glomerular filtration rate, HR, and UO were within normal limits in group-D. There was no pulmonary oedema.
DeltaIVCD-guided intravenous fluid therapy is valuable in low LVEF patients where tight fluid control is essential and any fluid overload may precipitate cardiac failure.
本研究旨在通过经食管超声心动图（TOE）测量接受减瘤肿瘤手术的左心室射血分数（LVEF）低下患者吸气和呼气时的下腔静脉直径（IVCD），以确定腔静脉指数（DeltaIVCD）与每搏量变异（SVV）之间是否存在任何相关性，并比较DeltaIVCD引导与SVV引导的液体治疗。
在这项前瞻性、平行组、干预性研究中，纳入了70例年龄在30 - 75岁、体重40 - 90 kg、LVEF≤40%且接受减瘤手术的美国麻醉医师协会III级患者，并将其随机分为D组（DeltaIVCD引导的液体治疗）和S组（SVV引导的液体治疗）。排除有食管病变的患者。在标准气管内麻醉后，放置动脉和颈内静脉导管。在D组干预中插入TOE探头。对IVCD呼吸变化进行量化。每30分钟记录心率（HR）、动脉血氧饱和度（SPO）、平均动脉压、呼气末二氧化碳（EtCO）、中心静脉压、SVV、IVCD和尿量（UO）。术后进行动脉血气分析、肺部超声、胸部X线片和血清肌酐检查。
使用Pearson相关系数作为线性关系强度的度量，计算回归方程，并对正态分布的连续变量进行非配对t检验。
观察到DeltaIVCD与SVV之间存在正相关（r = 0.751）。获得了SVV的回归方程（SVV = [0.317×DeltaIVCD] + 5.877）。D组的血清乳酸、估计肾小球滤过率、HR和UO均在正常范围内。没有肺水肿。
DeltaIVCD引导的静脉液体治疗在LVEF较低的患者中具有重要价值，这些患者需要严格控制液体量，任何液体过载都可能诱发心力衰竭。
