The Application Of Goal-directed Fluid Therapy Directed By Oesophageal Doppler Monitor In Patients Undergoing Living Donor Renal Transplant Surgery

Objective: To observe the application of goal-directed fluid therapy(GDFT)directed by oesophageal Doppler monitor(ODM)in patients undergoing living donor renal transplant surgery.Methods: 100 patients undergoing living donor renal transplant surgery,ASA Ⅲ~Ⅳ,were randomly divided into routine fluid therapy group(group CVP)and GDFT group monitered with ODM(group ODM)using random digits table.Patients were monitored with ECG,BP,Sp O2,PETCO2,NTI in the operating room.Intravenous anesthesia induction medicine are midazolam 0.03 mg/kg,propofol 2 mg/kg,sufentanil 0.4μg/kg,cisatracurium 0.15~0.2 mg/kg.Patients in all groups were ventilated mechanically after anesthesia induction(Fi O2:2 L/min,PETCO2:35~45 mm Hg).Hemodynamic parameters of two groups were recorded before anesthesia(T0),10 minutes after induction of anesthesia(T1),5 minutes before unclamping of the vessels(T2),at unclamping of the vessels after completion of the vascular anastomosis(T3)and at the end of surgery(T4).The amount of bleeding,infusion fluid and operative time were recorded.Urea nitrogen,creatinine,urine outputs were recorded before surgery and on days 1,2,4,10 and at 1 and 3 months after surgery.Results: The MAP of both groups at T3 were lower than before anesthesia(P<0.01),the CVP of group ODM was higher than group CVP at the point of T2,T3 and T4(P<0.05).The amount of intraoperative fluid given in group ODM was lower than in group CVP(P<0.01).Side-effects like postoperative dyspnoea and tissue edema were higher in group CVP.The postoperative graft function was comparable.Conclusion: ODM-guided intraoperative fluid therapy achieved the same rate of immediate graft function as CVP–guided fluid therapy but used a significantly less amount of fluid.The incidence of postoperative complications related to fluid overload was also reduced.