目标导向术中液体治疗对接受大型幕上肿瘤切除术患者的住院时间和术后并发症的影响。
Effect of Goal-Directed Intraoperative Fluid Therapy on Duration of Hospital Stay and Postoperative Complications in Patients Undergoing Excision of Large Supratentorial Tumors.
机构信息
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
出版信息
Neurol India. 2022 Jan-Feb;70(1):108-114. doi: 10.4103/0028-3886.336329.
BACKGROUND
Optimal fluid management during neurosurgery is controversial. Evidences suggest that goal-directed fluid therapy (GDFT) can improve postoperative outcome. This study aimed to assess the intraoperative use of GDFT on the duration of hospital stay and postoperative complications in patients undergoing craniotomy for large supratentorial tumors.
MATERIALS AND METHODS
Forty patients of 18-65 years age undergoing large supratentorial tumor surgery were prospectively randomized into two groups. Control-group received fluid regimen based on routine hemodynamic monitoring, whereas patients belonging to GDFT group received fluid based on stroke volume variation (SVV)-guided therapy. A colloid bolus of 250 ml 6% hydroxyl ethyl starch was given, if the SVV was more than 12% in the GDFT group. Hemodynamic parameters, such as blood pressure and heart rate, and dynamic parameters, such as cardiac index, stroke volume index, and SVV, were recorded at different time intervals.
RESULTS
The total amount of fluid required was significantly lower in GDFT (P = 0.003) group as compared to the Control group. Intraoperative complications were significantly lower in GDFT group (P = 0.005), but the incidence of tight brain was significantly higher in the control group. The duration of hospital stay (P = 0.07) and incidence of postoperative complications (P = 0.32) were lower in GDFT group. Neurological outcomes at-discharge were similar in both the groups.
CONCLUSIONS
This study did not show any benefit of GDFT over conventional intraoperative fluid therapy in terms of incidence of postoperative complications, hospital and ICU stay, and Glasgow outcome scores at-discharge in patients undergoing craniotomy for excision of large supratentorial tumors. However, the use of GDFT leads to better perioperative fluid management and brain relaxation scores.
CLINICAL TRIAL REGISTRY
CTRI/2016/10/007350.
背景
神经外科手术中的最佳液体管理存在争议。有证据表明，目标导向液体治疗（GDFT）可以改善术后转归。本研究旨在评估在接受大型幕上肿瘤开颅手术的患者中术中使用 GDFT 对住院时间和术后并发症的影响。
材料和方法
前瞻性随机将 40 例年龄在 18-65 岁之间的大型幕上肿瘤手术患者分为两组。对照组根据常规血流动力学监测接受液体方案，而 GDFT 组患者则根据每搏量变异（SVV）指导的治疗接受液体。如果 GDFT 组的 SVV 超过 12%，则给予 250ml 6%羟乙基淀粉胶体。记录不同时间间隔的血流动力学参数（如血压和心率）和动态参数（如心指数、每搏量指数和 SVV）。
结果
GDFT 组所需的总液体量明显低于对照组（P=0.003）。GDFT 组术中并发症明显较低（P=0.005），但对照组中紧密脑的发生率明显较高。GDFT 组的住院时间（P=0.07）和术后并发症的发生率（P=0.32）较低。两组出院时的神经功能结局相似。
结论
本研究未显示在接受大型幕上肿瘤切除术的患者中，与常规术中液体治疗相比，GDFT 在术后并发症、住院和 ICU 停留时间以及出院时格拉斯哥结局评分方面有任何优势。然而，GDFT 的使用可导致更好的围手术期液体管理和脑松弛评分。
临床试验注册号
CTRI/2016/10/007350。
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