Effects Of Different Levels Of Stroke Volume Variation Directed Fluid Therapy On Short Terms Of Prognosis In Patients With Portal Hypertension

Research No. 1 Study of the accuracy of SVV in predicting the fluid responsiveness in cirrhotic patients with portal hypertension undergoing splenectomy and pericardial devascularization under general anesthesiaObjective To evaluate of stroke volume variation (SVV) monitor the accuracy of the change of blood volume in cirrhotic patients with portal hypertension during splenectomy and pericardial devascularization.Methods Thirty eight patients undergoing elective splenectomy and pericardial devascularization surgery under general anesthesia were enrolled in the present study.Twenty minutes after general anesthesia, 0.4 ml/(kg·in) 6% hydroxyethyl starch was infused intravenously at a rate of 7 ml/kg. The data, including MAP, HR, CVP, SVI and SVV, was recorded before and after fluid infusion. We took △ SVI≥15% as the effective standards of the blood volume expansion, draw the ROC curve, calculated the area under the curve (AUC) and its 95% confidence interval, and compared of difference between the two sets of data.Results Of the 38 patients, 21 were responders and 17 were nonresponders. There were significantly changes of MAP,CVP and SVI after volume expansion(P<0.05).ROC curve analysis shows that AUC and 95% Confidence interval of SVV,CVP and MAP was 0.905 (0.808～1), 0.714 (0.542～0.886), 0.612 (0.421～0.803), respectively.The diagnostic threshold of SVV is 8.5% with a sensitivity of 85.7% and a specificity of 82.4%.Conclusions The accuracy of S W monitoring blood volume in patients with liver cirrhosis and portal hypertension is good, but the diagnostic threshold is so lower that we may be aware to guide fluid therapy of the cirrhotic patients.Research No. 2 Effects of different levels of stroke volume variation following goal-directed fluid therapy on short terms of prognosis in cirrhotic patients with portal hypertension under general anesthesiaObjective To observe the effects of different levels of stroke volume variation ( SVV )following goal-directed fluid therapy on shot terms of prognosis in cirrhotic patients.Methods 99 cirrhotic patients with portal hypertension undergoing pericardial devascularization surgeries were randomized into three groups on the basis of SVV level: high level (9%<SVV<13%) , middle level (5%<SVV<9%) and low level(1%<SVV<5%) .Each group accepted different fluid therapy strategy. Perioperative intake and output volume were recorded .Short term prognosis indicators included liver and kidney function and gastrointestinal function recovery, length of hospital stay after surgery and so on were collected. Postoperative complications were also recorded.Results Crystal, colloids, and total intake of three groups was significant difference(P<0.05). Stitche time was significant difference (P<0.05), there was only significant between high and low level. Portal vein thrombosis and infection incidence in middle level was lower than the other two groups (P<0.05).Conclusions The middle level (5%<SVV<9%) was more suitable for fluid management in cirrhotic patients with portal hypertension, may have a relatively quick recovery of gastrointestinal function and relatively fewer complications,as the best goal of perioperative fluid management.