A Randomized Controlled Analysis Of Fluid Management In Pneumonectomy Based On Different Levels Of Pulse Pressure Variation

ObjectiveTo evaluate the effect of different threshold pulse pressure variation-based goal-directed fluid therapies on early postoperative rehabilitation of patients with thoracoscopic pneumectomyMethodsA total of 171 patients admitted to the Second Affiliated Hospital of Anhui Medical University between August 2017 and November 2018 were included in this study.They were randomly divided into three groups(n=57):conventional therapy group(group C),in which patients received fluid therapy according to heart rate,mean arterial pressure,urine output,low PPV-based Goal-directed Fluid group(group G1),in which patients received fluid therapy to keep PPV between 3%and 6%,and high PPV-based Goal-directed Fluid group(group G2),in which patients received fluid therapy to keep PPV between 10%and 13%.The three groups were compared hemodynamic index、liquid balance、postoperative pulmonary complications at a week after operation、pulmonary function at 1 day、3 days and 7 days after operation,and length of postoperative hospital stay were recordedResultsThe HR of patients in the three groups showed a trend of changing with time at different time points,and the time effect was statistically significant(P＜0.05),while the group effect and interaction effect were not statistical significance(P＞0.05).The MAP of patients in the three groups showed a tendency to change with time and group at different time points,and the time effect and group effect had statistically significant(P＜0.05),while the interaction effect was not statistical significance(P＞0.05).The MAP value at each time point in the group G1 and group G2 was more stable than that in the group C.The Lac of patients in the three groups showed a tendency to change with time and group at different time points,and the time effect,group effect and interaction effect all had statistical significance(P＜0.05).The OI(PaO2/FiO2)of patients in the three groups showed a tendency to change with time and group at different time points,and the time effect and group effect had statistical significance(P＜0.05),while the interaction effect was not statistical significance(P＞0.05).The PaCO2 of patients in the three groups showed a tendency to change with the group at different time points,and the group effect was statistical significance(P＜0.05),while the time effect and interaction effect were not statistical significance(P＞0.05).The PaCO2 value at each time point in the group G1 and group G2 was more stable than that in the group C.The incidence of PPCs in groups C,G1,G2 was 35.09%、14.04%、28.07%,respectively There was statistical significance among three groups in the incidence of PPCs(χ2=6.855,P=0.032).The length of hospital stay in groups C,G1,G2 was(14.56±5.52)days、(11.42±3.83)days、(12.91±3.77)days.The length of hospital stay of G1 group was significantly shorter than that of group C and group G2(P＜0.05)ConclusionDuring GDFT for thoracoscopic pneumectomy,fluid boluses targeting lower PPV are beneficial than the other two groups,which can improve oxygenation,reduce the incidence of postoperative pulmonary complications,shorten the time of hospitalization in patients undergoing thoracoscopic pulmonary parenchyma resection.