| Purpose:The main purpose of fluid therapy is to maintain the body effective circulating blood volume, guarantee necessary oxygen for organization and organs, maintain the balance of water, electrolyte and acid-base metabolism of the body, against the body damage that may caused by surgical trauma, as well as being most of the carrier in the process of perioperative period should both to avoid concealed hypovolemia and low infusion caused by the lack of intravascular infusion, and also avoid cardiac insufficiency and peripheral tissue edema that may caused by Infusion too much. Perioperative fluid therapy is the subject of much controversy, the debate of "restricted intravenous fluid therapy" and "standard fluid therapy", and the debate of using crystal or colloid have been inconclusive for decades, each group according to his own opinion to outdo each other. In recent years, goal-directed fluid therapy has gradually caused the attention of anesthesia doctors and clinicians, the so-called goal-directed fluid therapy is the process of implementing real-time fluid treatment is based on the real-time circulation function status of each patient under anesthesia or surgery. Compared with restricted intravenous fluid therapy, the goal-directed fluid therapy neither increase the infusion amount, and can obtain better circulation function, tissue perfusion and oxygenation index. However, how to obtain the optimal perioperative fluid therapy in order to make sure patients vital signs stable during perioperative period and reduce postoperative complications, and how to define the "goal" of the "goal-directed fluid therapy", in what quantitative indicators that can be measured to reflect,are all of no clear standards currently and still need further study. Stroke volume variation (SVV) is a kind of dynamic parameters of fluid management, SVV is based on the interaction of the heart and lungs of the patients who were mechanical ventilationed under general anesthesia, and several studies have confirmed the value of SVV guide fluid therapy is superior to the traditional static index (e.g., CVP, PCWP, etc.). Under the condition of mechanical ventilation controls breathing, SW is to calculate the the difference between the maximum number of every stroke of a respiratory cycle (SVmax) and the minimum amount of stroke (SVmin), and then calculate the ratio between that difference and average value of stroke volume (SVmean), SVV can predict heart response capacity to the volume load and the relationship with Frank-Starling curve that reflected cardiac function. SW is considered to be a good predictor of reactive capacity, and has high sensitivity and specificity in the prediction of rehydration reaction, SVV has been applied in varies of clinical practices as an important approach to guide fluid therapy during perioperative fluid management in recent years, but there are still some factors restricting its application in the clinical practice in the daily work. The purpose of this paper is to analyze the value of using stroke volume variation to guide perioperative fluid therapy, and to find a accurate and feasible goal for goal directed and optimizing fluid therapy during perioperative period.Methods:Meta analysis is a commonly used statistical method in the systematic review (SR), and has the very high potency ratio. This article selects the corresponding clinical data, retrieve relevant literature in the Medline database, using SVV, fluid therapy for primary retrieval word, this paper retrieved the literatures from2000to the present, the research got74related papers, through reading the full text or abstract in depth, those clinical research which study and evaluate the value of the dynamic capacity indicator SVV in predicting fluid responsiveness were included in the final meta analysis. Animal experimental research, the literature of review, cases of spontaneous breathing in patients in the clinical research, and the literature cannot get the relevant data have been dropped, and the referenced documents of those literatures included in the final meta analysis were read one by one to judge whether to increase the final included literature amount. And then conducted meta analysis with the final included clinical researchs, and to discuss the value of accuracy of SVV guiding fluid treatment.Results:A total of420patients from11studies were included in the final meta analysis of this article, all the literatures included in are those clinical researches which study and evaluate the value of the dynamic capacity indicator stroke volume variation (SVV) in predicting fluid responsiveness.The case sources including the operating room (OR) and Intensive Care Unit (ICU), all the patients included were in mechanical control breathing and the tidal volume were8-10ml/kg. After the quality evaluation of the included literature, then extract related data information from the literature, mainly including research design, sample size, setting of research plan, the number of patients included in the study, hemodynamic detection method, liquid type during the fluid therapy, definition standard of fluid load positive, the correlation coefficient, threshold of SVV predicting fluid responsiveness and its sensitivity and specificity, and the receiver operating characteristic curve (AUC) for SVV in predicting fluid responsiveness, and the95%confidence interval(CI), etc. Baseline SVV was correlated to fluid responsiveness with a pooled correlation coefficient of0.718. Across all settings, we found a diagnostic odds ratio of26.291(95%CI16.057-43.048) for SVV to predict fluid responsiveness at a sensitivity of82.3%(95%CI0.773-0.866) and specificity of85%(95%CI0.796-0.895), the positive likelihood ratio of5.245(95%CI3.827-7.188),the negative likelihood ratio of0.21(95%CI0.161-0.273), and the receiver operating characteristic curve (AUC) for SVV was0.9052. The SVV was of diagnostic value for fluid responsiveness in operating room (OR) or Intensive Care Unit (ICU) patients monitored with the PiCCO or the FloTrac/Vigileo system.Conclusion:Stroke volume variation (SVV) can be a sensitive indicator to evaluate fluid responsiveness, and can be guide perioperative fluid management to reach the fluid therapy optimization. |
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