Effect of goal-directed fluid therapy based on stroke volume variation guidance on splanchnic perfusion in elderly patients undergoing lumbar spine surgery: evaluation using gastric mucosal pH value
10.3760/cma.j.cn131073.20211212.00412
- VernacularTitle:SVV目标导向液体治疗对腰椎手术老年患者内脏灌注的影响：采用胃黏膜内pH值评价
- Author:
Xia CHEN
1
;
Jinbao WANG
;
Weiguo CHEN
;
Zongfeng GUO
Author Information
1. 南通大学附属海安市人民医院麻醉科，海安 226600
- Keywords:
Stroke volume;
Fluid therapy;
Lumbar vertebrae;
Aged;
Gastric Mucosa;
Hydrogen-ion concentration
- From:
Chinese Journal of Anesthesiology
2022;42(4):435-438
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effect of goal-directed fluid therapy (GDFT) based on stroke volume variation (SVV) guidance on splanchnic perfusion using gastric mucosal pH (pHi) value in elderly patients undergoing lumbar spine surgery.Methods:One hundred and sixty elderly patients of either sex, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective lumbar spine surgery under general anesthesia, were selected and divided into 2 groups ( n=80 each) using a random number table method: SVV-guided GDFT group (group G) and conventional fluid therapy group (group C). GDFT was performed with SVV<15% as the target in group G, while conventional fluid infusion was performed under the guidance of mean arterial pressure, central venous pressure and urine volume in group C. Intraoperative amount of crystalloid solution infused, amount of colloid solution infused, total volume of fluid infused, amount of bleeding, urine volume, use of vasoactive drugs and perioperative blood transfusion were recorded in both groups.Cardiac index, SVV, pHi, gastric intramucosal partial pressure of CO 2 (PgCO 2), PaCO 2 and results of arterial blood gas analysis were also recorded before induction of anesthesia (T 1), at 1 h after the start of surgery (T 2) and at the end of surgery (T 3). The postoperative complications, time to first flatus, time to defecation and duration of hospital stay were also recorded in both groups. Results:Compared with group C, the amount of intraoperative crystalloid solution infused, total volume of fluid infused, urine volume and requirement for vasoactive drugs were significantly decreased, the amount of colloid solution infused was increased, cardiac index and pHi value were increased at T 2, 3, and SVV, Pg-aCO 2 and arterial blood lactic acid concentrations were decreased ( P<0.05), and no significant changes were found in the intraoperative amount of bleeding, arterial blood pH value, PaCO 2 and base excess, incidence of postoperative complications, time to first flatus, time to defecation and duration of hospital stay in group G ( P>0.05). Conclusions:GDFT based on SVV guidance is superior to traditional fluid therapy in improving splanchnic perfusion in elderly patients undergoing lumbar spine surgery.
