基于每搏量变异度指导的术中液体管理方案对胰十二指肠切除术后手术结局的临床影响：一项回顾性队列研究。
The clinical impact of the systolic volume variation guided intraoperative fluid administration regimen on surgical outcomes after pancreaticoduodenectomy: a retrospective cohort study.
机构信息
Universidade Federal do Estado do Rio de Janeiro, Departamento de Anestesiologia, Rio de Janeiro, RJ, Brazil; Faculdade de Medicina da Fundação Universitária Serra dos Órgãos, Teresopolis, RJ, Brazil.
Faculdade de Medicina da Fundação Universitária Serra dos Órgãos, Teresopolis, RJ, Brazil.
出版信息
Braz J Anesthesiol. 2022 Nov-Dec;72(6):729-735. doi: 10.1016/j.bjane.2022.06.008. Epub 2022 Jul 7.
BACKGROUND
Pancreaticoduodenectomy is associated with high morbidity. Many preoperative variables are risk factors for postoperative complications, but they are primarily non-modifiable. It is not clear whether an intraoperative goal-directed fluid regimen might be associated with fewer postoperative surgical complications compared to current conservative, non-goal-directed fluid practices. We hypothesize that the use of Systolic Volume Variation (SVV)-guided intraoperative fluid administration might be beneficial.
METHODS
Data from 223 patients who underwent pancreaticoduodenectomy in our institution between 2015 and 2019 were reviewed. Patients were classified into two groups based on the use of intraoperative use of SVV to guide the administration of fluids. The decision to use SVV or not was made by the attending anesthesiologist. Subjects were classified into SVV-guided intraoperative fluid therapy (SVV group) and non-SVV-guided intraoperative fluid therapy (non-SVV group). Uni and multivariate regression analyses were conducted to determine if SVV-guided fluid therapy was significantly associated with a lower incidence of postoperative surgical complications, such as Postoperative Pancreatic Fistula (POPF), Delayed Gastric Emptying (DGE), among others, after adjusting for confounders.
RESULTS
Baseline, demographic, and intraoperative characteristics were similar between SVV and non-SVV groups. In the multivariate analysis, the use of SVV guidance was significantly associated with fewer postoperative surgical complications (OR = 0.48; 95% CI 0.25-0.91; p = 0.025), even after adjusting for significant covariates, such as perioperative use of epidural, pancreatic gland parenchyma texture, and diameter of the pancreatic duct.
CONCLUSIONS
VV-guided intraoperative fluid administration might be associated with fewer postoperative surgical complications after pancreaticoduodenectomy.
背景
胰十二指肠切除术相关的发病率较高。许多术前变量是术后并发症的危险因素，但它们主要是不可改变的。目前尚不清楚术中目标导向的液体方案是否与当前保守的非目标导向的液体方案相比，与较少的术后手术并发症相关。我们假设使用收缩期容量变异（SVV）指导术中液体管理可能是有益的。
方法
回顾了 2015 年至 2019 年在我们机构接受胰十二指肠切除术的 223 例患者的数据。根据术中使用 SVV 指导液体管理，将患者分为两组。是否使用 SVV 由主治麻醉师决定。受试者分为 SVV 指导的术中液体治疗（SVV 组）和非 SVV 指导的术中液体治疗（非 SVV 组）。进行单变量和多变量回归分析，以确定 SVV 指导的液体治疗是否与术后手术并发症（如术后胰腺瘘（POPF）、胃排空延迟（DGE）等）的发生率显著降低相关，在调整混杂因素后。
结果
SVV 和非 SVV 组的基线、人口统计学和术中特征相似。在多变量分析中，SVV 指导的使用与较少的术后手术并发症显著相关（OR=0.48；95%CI 0.25-0.91；p=0.025），即使在调整了围手术期硬膜外使用、胰腺实质质地和胰管直径等显著混杂因素后也是如此。
结论
SVV 指导的术中液体管理可能与胰十二指肠切除术后较少的术后手术并发症相关。
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