Clinical Observation Of Using SVV And CVP For Guiding Fluid Management During The Renal Transplantation

Objective:Analysis and comparison of SVV and CVP monitoring,whether guiding the clinical value of fluid management protocol for prognosis in renal transplantation.Method:56 patients undergoing DCD allograft renal transplantation between March 2016 to October 2017 were selected from the Gan Mei Affiliated Hospital of Kunming Medical University,and were divided into S group(SVV)and C group(CVP)according to surveillance methods.Patients were 32 males and 24 females,with a mean age of 18-55 years,ASA physical status ?-?V,all patients included in this study were accompanied by varying degrees of renal hypertension,renal anemia,water and electrolyte acid-base disorders,chronic renal insufficiency More than 1 year history,regular dialysis.Everyone must has hemodialysis before the surgery that 12-48 hours ago.Both groups use the same method of anesthesia.S group was instructed to monitor infusion by monitoring SVV value,and SVV remained less than 10%during the operation.In group C,the infusion was monitored by CVP monitoring.When CVP<6 mmHg,supplemental capacity was maintained and CVP was maintained at 6-9 mm Hg.When MAP was less than 20%of the baseline value,vasoactive drugs were pumped;MAP was always greater than 90 mmHg.Renal blood pressure was maintained at 140-160/70-90 mmHg when renal grafts were opened.CVP,MAP and HR,intraoperative intake and output volume,postoperative dialysis rate and postoperative hospitalization days,etc.in both groups were compared and studied at the following 4 time points:5 min before surgery(T1),external iliac vein occlusion(T2),renal blood vessels opening(T3),and end of procedure(T4).Results:The total infusion volume in the S group was significantly higher than that in group C(P<0.05).The postoperative dialysis rate of S group was significantly lower than that of group C.There was no statistical difference of total intake volumes,Intraoperative urine output,and blood loss 3 days after operation and renal function indicators between two groups.But CVP group were generally showing a rising trend.Conclusion:Stroke volume variation(SVV)guiding goal-directed liquid therapy could maximize the guarantee of intraoperative renal perfusion compared with the traditional CVP guiding fluid management scheme,and contribute to postoperative outcomes in patients with renal transplantation.