Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, USC, 1441 Eastlake Ave. NOR 7416, Los Angeles, CA, 90089, USA.
Department of Anesthesiology, University of Southern California, Los Angeles, CA, USA.
Int Urol Nephrol. 2021 Sep;53(9):1827-1833. doi: 10.1007/s11255-021-02903-w. Epub 2021 Jun 4.
The aim of this study is to evaluate the intra/perioperative fluid management and early postoperative outcomes of patients who underwent radical cystectomy with Enhanced Recovery After Surgery protocol, using goal-directed fluid therapy compared to conventional fluid therapy.
This cohort study included patients who underwent open RC for urothelial bladder carcinoma with intent to cure and Enhanced Recovery After Surgery protocol between May 2012 and August 2019. Patients who had palliative or salvage cystectomy and/or adjunct procedures, as well as those with missing detailed perioperative data were excluded. Data were compared between patients who received goal-directed fluid therapy using stroke volume variation by FloTrac™/Vigileo system (n = 119) and conventional fluid therapy based on the anesthesiologist discretion (n = 192). Primary outcome variable was 90-day complications and secondary outcome measures included in-hospital GFR trend, length of stay, and 90-day readmission.
The goal-directed fluid therapy group received less total and net intra/perioperative fluid, yet early postoperative glomerular filtration rate trends were similar between both groups (p = 0.7). Estimated blood loss, blood transfusion, index hospital stay, 90-day complication and readmission rates were also comparable between the two groups. Multivariable logistic regression showed no significant association between perioperative fluid management method and 90-day complication rate (OR 1.4, 95% CI 0.8-2.4, p = 0.2).
Stroke volume variation guided goal-directed fluid therapy is safe in radical cystectomy without compromising the renal function. It is associated with less intra- and perioperative fluid infusion; however, no association with hospital stay, 90-day complication or readmission rates were noted.
本研究旨在评估接受根治性膀胱切除术（RC）的患者采用目标导向液体治疗（使用 FloTrac/Vigileo 系统测量每搏量变异度）与常规液体治疗相比，在强化康复后治疗（enhanced recovery after surgery，ERAS）方案下的围手术期液体管理和早期术后结局。
本队列研究纳入 2012 年 5 月至 2019 年 8 月期间接受开放性 RC 治疗肌层浸润性膀胱癌且符合 ERAS 方案的患者。排除姑息性或挽救性膀胱切除术和/或辅助手术以及围手术期数据缺失的患者。比较接受目标导向液体治疗（n=119）和根据麻醉师判断接受常规液体治疗（n=192）的患者的 90 天并发症等主要结局变量和次要结局指标，包括住院期间肾小球滤过率（glomerular filtration rate，GFR）趋势、住院时间和 90 天再入院率。
目标导向液体治疗组的总液体和净液体输入量较少，但两组术后早期 GFR 趋势相似（p=0.7）。两组的估计失血量、输血、住院指数、90 天并发症和再入院率也相似。多变量逻辑回归显示，围手术期液体管理方法与 90 天并发症发生率之间无显著相关性（比值比 1.4，95%置信区间 0.8-2.4，p=0.2）。
在不影响肾功能的情况下，使用每搏量变异度指导的目标导向液体治疗在 RC 中是安全的。它与术中及术后液体输注量减少有关，但与住院时间、90 天并发症或再入院率无关。
