The Research Of The Stroke Volume Variation In Different Tidal Volumes Undergoing One-lung Ventilation Esophageal Cancer Patients

Objectives:Observed FloTrac/Vigileo cardiac output monitoring syst em for stroke volume variation (SVV) monitoring indicators used in eso phageal cancer to stroke volume variation (SVV) to determine the expan sion effect of different tidal volumes in theintraoperative one-lung ventil ation in patients with fluid therapy accuracy.Methods:Intended40cases of esophageal cancer patients with radi cal surgery under general anesthesia, age35to60years of age, body mass index of18kg/m2,25kg/m2, ASA Ⅰ or Ⅱ level, no previous hist ory of serious arrhythmia history, good blood pressure control and non-t argetorgan damage, the estimated operation time of3-4hours. Open the upper extremity venous access in patients with burglary,1%lidocainelo cal anesthesia, a20G radial artery puncture in the right side of the arte rial and venous catheter line (non-operative side), Connection after succe ssful catheter the FloTrac flow pressure sensor, the sensorend of the co nnection FloTrac/Vigileo monitor, advance to enter the patients'gende r, age, height, weight and other data, to zero after the cardiac output (CO),stroke volume (SV), cardiac index (CI), stroke volume variation (S VV),hemodynamic monitoring indicators; connect the other end multifunc tional monitorto zero after measurement of invasive arterial pressure.5m1/kg/h the rate of intravenous infusion of lactated Ringer solution, to su pplementthe missing amount and intravenous fentany14μg/kg, propof o12mg/kg,cis-atracurium0.15mg/kg conductinduction of anesthesia, musc le relaxantsimprove tracheal intubation, oral, as to insert a left sided DL T.(Male-F39or F37, for women F37or F35,) Via lungs auscultation a nd fiberoptic broncho scopy to determine the correctcatheter position, pro perly secured catheter line lung mechanical ventilation, set the8ml/kg of tidal volume, inspiratory to expiratory ratio of1:1.5, and regulation of breathing frequency so that the end-tidal carbon dioxide partial pres sure(of PETCO2) maintained at30～40mmHg. Change the lateral positi on again afterauscultation to determine the correct position of the endotr acheal tube. Into the chest changed to one-lung ventilation, the use of r andom number table,patients were randomly divided into two groups, th e group (on the20cases ineach group (n=20):tidal volume8ml/kg g roup (VI group) and tidal volume6ml/kgV2group), two groups set the ventilation frequency of12to14times/min,inspiratory to expiratory r atio1:1.5,100%of the oxygen concentration, PEEP=0maintain PETCO2maintained at30-40mm Hg (1mm Hg=0.133kPa),gaspeak inspirato ry pressure <30cmH2O (1cmH20=0.098KPa), Induction of anesthesi a and underwent right internal jugular vein or right subclavian vein pun cture inserted central venous catheter, connected Edawards ordinary press ure sensors to monitor central venous pressure (CVP). Data collection u ntil all parameters stable. Again after a change of lateral position auscul tation to determine the correct position of the endotracheal tube into the chest changed to non-operative side of one-lung ventilation mode, the t wo groups in one-lung ventilation30min after volume load test, intrave nous infusion of6%within30minutes hydroxyethyl starch (130/0.4)500ml. One-lung ventilation30min after infusion, immediately before (T1) and3min (T2) after the infusion ended, the record of the MAP, H R, of CO, SV, the CVP, SVI, CI and SVV calculation of the CI rate o f change (△CI,). The two groups T1and T2, MAP, HR, CO, SV, th e CVP, SVI, CI, of SVV, respectively, and△CI test.△CI>15%ex pansion of the effective standards, respectively, to draw two different S VV determine the blood volume changes in the ROC curve, calculate th e area under the curve (AUC) and its95%confidence interval (95%C Results:No significant linear correlation between the one-lung venti lation tidal volume6ml/kg group, MAP, HR, CO, and CVP, SVI, CI, a nd SVV the basis of the value of△CI. No significant linear correlatio n between the one-lung ventilation tidal volume8ml/kg group, MAP, H R, CO, and CVP, SVI, CI, and SVV the basis of the value of△CI,. One-lung ventilation tidal volume6ml/kg group, the△CI>15%for th e expansion of effective standards of SVV monitoring blood volume cha nges in the threshold value of7.5%, the area under the ROC curve wa s0.561(95%confidence interval0.298to0.824) sensitivity0.727, speci ficity of0.444. One-lung ventilation tidal volume8ml/kg group, the△CI>15%for the expansion of effective standards of SVV monitoring bl ood volume changes in the threshold value of10.5%, area under the R OC curve was0.703(95%confidence interval0.454to0.953) sensitivit y0.857, specificity of0.692.Conclusions:Esophagectomy was performed in lateral position duri ng OLV, whether it is areactive one-lung ventilation8ml/kg group or o ne-lung ventilation6ml/kg group of SVV are not effectively predict flui d therapy.