脉搏压力变化(PPV)引导下的成年幕上肿瘤手术患者的液体管理:一项随机对照试验

Janani Gopal, Shashi Srivastava, Nidhi Singh, Rudrashish Haldar, Ruchi Verma, Devendra Gupta, Prabhakar Mishra
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Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed. Statistical Analyses All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t-test was used for normal distribution data and Mann–Whitney U test for nonnormal distribution data. 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引用次数: 0

摘要

摘要目的考虑到继发性脑损伤的风险,神经外科手术中适当的液体管理至关重要。由于静态变量不可靠,体积状态的确定具有挑战性。目标导向的流体治疗与动态变量可以可靠地确定流体反应,并承诺更好的结果。我们的目的是比较传统的中心静脉压(CVP)引导和脉压变化(PPV)引导下的幕上肿瘤手术中的液体需求。材料和方法本前瞻性、随机、双盲、单中心试验对72名成人进行仰卧位幕上肿瘤手术。患者被分为两组,每组36例患者接受CVP和ppv引导的液体治疗。CVP引导组接受CVP大于8mmhg的靶剂量,同时每小时补充术中损失和维持液体。PPV引导组在补充维持液的同时,给予目标PPV低于13%的药物。术中给予的总液体和低血压的发生率与脑放松评分一起记录。术后评估血清乳酸水平、眶周和结膜水肿以及术后恶心和呕吐。所有统计分析均使用Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States)进行。为比较两组间的均数(CVP vs. PPV),正态分布资料采用独立样本t检验,非正态分布资料采用Mann-Whitney U检验。对分类变量使用卡方检验或菲舍尔精确检验。结果CVP组术中液体量明显多于PPV组(4340±1010 mL vs 3540±740 mL);0.01)。PPV组低血压发生率较低(4[11.1%]比0 [0%],p = 0.04)。脑松弛评分、血清乳酸水平、眶周和结膜水肿以及术后恶心和呕吐发生率在两组之间具有可比性。结论ppv引导下的液体管理术中液体需要量少,血流动力学稳定性好,脑条件充足,不影响血流灌注。
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Pulse Pressure Variance (PPV)-Guided Fluid Management in Adult Patients Undergoing Supratentorial Tumor Surgeries: A Randomized Controlled Trial
Abstract Objective Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries. Materials and Methods This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed. Statistical Analyses All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t-test was used for normal distribution data and Mann–Whitney U test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables. Results The CVP group received significantly more intraoperative fluids than the PPV group (4,340 ± 1,010 vs. 3,540 ± 740 mL, p < 0.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], p = 0.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups. Conclusion The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.
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