Koo Bon-Wook, Oh Ah-Young, Na Hyo-Seok, Han Jiwon, Kim Hyeong Geun
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea.
PLoS One. 2024 Dec 18;19(12):e0315205. doi: 10.1371/journal.pone.0315205. eCollection 2024.
Intraoperative fluid balance significantly affects patients' outcomes. Goal-directed fluid therapy (GDFT) has reduced the incidence of major postoperative complications by 20% for 30 days after open abdominal surgery. Little is known about GDFT during laparoscopic surgery.
We investigated whether GDFT affects the postoperative outcomes in laparoscopic hepatobiliary or pancreatic surgery compared with conventional fluid management.
This interventional comparative study with a historical control group was performed in the tertiary care center. Patients were allocated to one of two groups. The GDFT (n = 147) was recruited prospectively and the conventional group (n = 228) retrospectively. In the GDFT group, fluid management was guided by the stroke volume (SV) and cardiac index (CI), whereas it had been performed based on vital signs in the conventional group. Propensity score (PS) matching was performed to reduce selection bias (n = 147 in each group). Postoperative complications were evaluated as primary outcome measures.
The amount of crystalloid used during surgery was less in the GDFT group than in the conventional group (5.1 ± 1.1 vs 6.3 ± 1.8 ml/kg/h, respectively; P <0.001), whereas the amount of colloid was comparable between the two groups. The overall proportion of patients who experienced any adverse events was 57.8% in the GDFT group and 70.1% in the conventional group (P = 0.038), of which the occurrence of pleural effusion was significantly lower in the GDFT group than in the conventional group (9.5% vs. 19.7%; P = 0.024). During the postoperative period, the proportion of patients admitted to the intensive care unit (ICU) was lower in the GDFT group than that in the conventional group after PS matching (4.1% vs 10.2%; P = 0.049).
GDFT based on SV and CI resulted in a lower net fluid balance than conventional fluid therapy. The overall complication rate in laparoscopic hepatobiliary or pancreatic surgery decreased after GDFT, and the frequency of pleural effusion was the most affected.
术中液体平衡显著影响患者的预后。目标导向液体治疗（GDFT）已使开腹手术后30天内的主要术后并发症发生率降低了20%。关于腹腔镜手术期间的GDFT知之甚少。
我们研究了与传统液体管理相比，GDFT是否会影响腹腔镜肝胆或胰腺手术的术后结局。
在三级医疗中心进行了这项带有历史对照组的干预性比较研究。患者被分配到两组中的一组。前瞻性招募GDFT组（n = 147），回顾性招募传统组（n = 228）。在GDFT组中，液体管理以每搏量（SV）和心脏指数（CI）为指导，而在传统组中则基于生命体征进行。进行倾向评分（PS）匹配以减少选择偏倚（每组n = 147）。将术后并发症作为主要结局指标进行评估。
GDFT组手术期间使用的晶体液量少于传统组（分别为5.1±1.1与6.3±1.8 ml/kg/h；P<0.001），而两组之间胶体液量相当。GDFT组发生任何不良事件的患者总体比例为57.8%，传统组为70.1%（P = 0.038），其中GDFT组胸腔积液的发生率显著低于传统组（9.5%对19.7%；P = 0.024）。在术后期间，PS匹配后GDFT组入住重症监护病房（ICU）患者的比例低于传统组（4.1%对10.2%；P = 0.049）。
基于SV和CI的GDFT导致的净液体平衡低于传统液体治疗。GDFT后腹腔镜肝胆或胰腺手术的总体并发症发生率降低，胸腔积液的发生率受影响最大。
