The Clinical Observation On SVV, CVP, CI Directing Fluid Infusion In Gastric Surgical Patients

Objectives: To evaluate the clinical observation on SVV,CVP,CI directing fluid infusion in gastric surgical patients.Methods: Forty patients with gastric cancer, aged 40-65years, weight 56-80 kg, height 156¹79cm, no cardio-pulmonary disease, ASAâ… orâ…¡, were chosen in the study. The patients were divided into two groups randomly:standard fluid replacement group (group A)and SVV,CVP,CI directing fluid infusion group(goal-directed fluid replacement group ,group B). On arrived to the operating room, MAP,HR,ECG,SpO₂ were monitored routinely, a catheter was inserted in the radial artery and connected to the FloTrac/Vigileo system to obtain SVV,CI,COand SV measurements. Central venous pressure(CVP)was recorded through cannulation. Anaesthesia was induced by fentanyl 4μg/kg, propofol 1.5-2 mg/kg, cis-atracurium 0.2 mg/kg and maintained with sevoflurane at a expiratory concentration of 2-3%. After tracheal intubation, the patients were volume-controlled ventilation with tidal volume 8 mg/kg,I:E=1:1.5, ventilatroy frequency 12 bpm. In group A, the fluid infusion introduced by《Anaesthesiology》( third edition ) was implemented. In group B, the fluid management was given according to SVV,CI,CVP.MAP,HR,SVV,CI,CVP were recorded at the time of patient entered into the operation room, after anaesthesia induction, at the start of the surgery, at different time points during the surgery every 20 minutes, at the end of the surgery, respectively. The crystalloid and colloid requirements, the time of the surgery, urinary output and the loss of the blood were recorded, oxygen metabolism was evaluated after anaesthesia induction and at the end of the surgery. The concentration of theβ₂-MG,TNF-α,IL-4,IL-8 were examined when patient entering the operation room and at the end of the surgery, respectively. The DO₂,VO₂,ERO₂ and the concentration of the LD were examined after anaesthesia induction and at the end of the surgery, respectively.The peristalsis recovery time, the liquid intake time and the complications were recorded.Results:1 The general information in the two groups were no significant differences in ages, weigh, height ,the time of surgery, the value of blood loss(p>0.05) .2 The data of the hemodynamicsThere were no differents at MAP,CVP,HR,SVV between two groups when the patients enter the operation room. After anesthesia induction, HR increased ,MAP was significant lower than the time when the patients enter the operation room in the two groups(P<0.05),and MAP,CI in group B was significant higher than that in group A when the surgery begain (P<0.05),SVV in group B was significant lower than that in group A when the surgery begain(P<0.05). There was no significantly different in two groups of HR(P>0.05).CVP were gradually increase in two groups after anesthesia induction.The adverse events of hemodynamics in group A were higher than in group B(P<0.05).3 Inflammatory markers andβ₂-MGCompared with the bases data, in the two groups ,the expressions of TNF-α,IL-8,IL-4,β₂-MG increased significantly at the end of the operation(p<0.05). Compared with group A, in group B the expressions of TNF-α,IL-8,β₂-MG was less than in group A (p<0.05), the expressions of IL-4 was higher than in group A (p<0.05).4 The effects of different fluid therapy on DO₂,VO₂,ERO₂ and LDAt the end of operation, in group B,DO₂,VO₂,ERO₂ were higher compared with the time of anaesthesia induction, and higher then in group A (P<0.05).Compared with the time of induction, the expressions of LD in two groups were significant increased at the end of the operation(P<0.05). Group A was higher then Group B at the end of the operation(p<0.05). 5 The liquid volume and the peristalsis recoveryThe crystals volume in group A was more than in group B(P<0.05).The amount of colloid and the amount of urine in group B were more than in group A(P<0.05).The peristalsis recovery time and the liquid intake time in group B were significantly shorter than in group A(p<0.05). 6 The complicationsThere were no significant differences of complications in two groups (Pï¹¥0.05).Conclusions: Using SVV,CVP,CI directing infusion in gastric surgical patients can maintain hemodynamic steadily and offer the best blood volume, alleviates inflammatory reaction, improve immunity function, enhance gastrointestinal functional recovery.