The Investigation Of Volume Administration Guided By Stroke Volume Variation In Elective Gastrointestinal Surgery

[Objective] To investigate the applicability of stroke volume variation as an index of volume administration in elective gastrointestinal surgery and the effect on gastrointestinal functional recovery and postoperative outcome. Methods Sixty patients undergoing elective gastrointestinal surgery were randomly divided into 2 groups. Group A: protocol group that received volume administration guided by stroke volume variation. The goal SVV was 10±2. Group B: control group that received standard intraoperative volume administration. The primary clinical outcome: the time of passing gas. The secondary outcomes: liquid intake time, solid intake time, length of hospital stay, mortality (death), morbidity (complications). Edwards Flotrac sensor and Edwards Vigileo monitor was used to offer parameters of cardiac output (CO),stroke volume(SV),stroke volume variation (SVV) continuously. Arterial pressure and central venous pressure was also measured continuously. All patients received general anaesthesia, tracheal catheterized and mechanical ventilation. Hemodynamic monitoring parameters (ABP,HR,CVP,CO,SV,SVV) were noted at these time points: right before induction(T1), right before incision(T2) ,right after open peritoneal cavity(T3) , during bowel anastomose(T4) , right after abdomen wall closure(T5). The dosage and times of applying ephedrine or atropine was also noted. Duration of surgery, blood loss, urine output was registered. Intravenous fluid volume (intraoperative, postoperative) was registered. The laboratory data such as hemoglobin, hematocrit, lactic acid, Cr, BUN was examined the day before and after operation. The time of passing gas, the time of defecate, liquid intake time, solid intake time, length of hospital stay, death, complications was examined. Results Hemodynamic monitoring parameters (ABP,HR,CO,SV) ,the dosage of intraoperative fentanyl,ephedrine and atropine are no statistically significant difference between the two groups. The intraoperative intravenous fluid volume in group A is significant less than in group B ( P<0.01). Urine output in group A is significant less than in group B ( P<0.05 ) . Postoperative hemoglobin, hematocrit is statistically significant lower versus preoperative. There was no significant difference between the two groups. Postoperative lactic acid is no significant difference versus preoperative and all in normal circumsciption. Postoperative, Cr,BUN in group A is no significant difference versus preoperative while in group B. Cr,BUN is significant lower ( P<0.01) . There was no significant difference between the two groups. The time of passing gas and the time of defecate in group A is significant less than in group B( P<0.01). Liquid intake time and solid intake time in group A is significant shorter than in group B ( P<0.05 ) .The length of hospital stay in group A is significant shorter than in group B ( P<0.01) .There was no case of death in two groups. Complications in two groups have no statistically significant difference. Conclusion Stroke volume variation measured from Edwards Flotrac sensor and Edwards Vigileo monitor can be a security and sensitive parameter as an index of volume administration. In elective gastrointestinal surgery ,volume resuscitation with a goal SVV of 10±2 not only reduced intravenous fluid volume but also maintenance the stable of hemodynamic and tissue perfusion, enhanced gastrointestinal functional recovery and reduced the length of hospital stay.