The Impact Of The First Central Venous Pressure Monitoring After Surgery On The Short-term Prognosis Of Severe Patients During Perioperative Period

ObjectiveTo investigate the impact of the first central venous pressure monitoring after surgery on the short-term prognosis of critical patients during perioperative period.MethodsA total of 196 perioperative patients admitted at our department from February 2014 to March 2018 were retrospectively studied.According to the first central venous pressure after surgery（defined as CVP1）the patients were divided into three groups:group A:CVP1<8 mm Hg（49 cases）,group B:8 mm Hg≤CVP1≤12 mm Hg（98cases）,group C:CVP1>12 mm Hg（49 cases）.The general demographic data of all patients（including age,sex,history,basic blood creatinine value）,the operation-related data（including type of operation,duration of operation,intraoperative blood transfusion）,the postoperative clinical indicators（mean arterial pressure,heart rate,central venous pressure,Pa O₂/Fi O₂ratio,Pa CO₂,lactate,serum creatinine,hemoglobin,troponin I,N-teriminal probrain natriuretic peptide,dosage of vasoactive drugs,mode and concentration of oxygen supply,Acute Physiology And Chronic Health Evaluation Scoring System II and Sequential Organ Failure Assessment in the first 24 hours）were collected.We compared perioperative fluid balance（cumulative intraoperative fluid balance,cumulative fluid balance from admission to 6 hours after operation and 24hours after operation）,28-day mortality,length of stay in intensive care unit,lengths of hospitalization and surgical complications among groups.In the subgroup analysis,the critically ill patients undergoing neurosurgery were divided into three groups according to CVP1:group D:CVP1<8 mm Hg（31 cases）,group E:8 mm Hg≤CVP1≤12 mm Hg（63 cases）,group F:CVP1>12 mm Hg（33 cases）.The perioperative volume and prognosis indexes were compared,and the correlation between perioperative volume and CVP1 was studied.Results1.In terms of perioperative fluid infusion,the cumulative intraoperative fluid balance in group A was the least,followed by group B,and group C was the most[A vs B vs C:700（500,1090）vs 1060（868,1500）vs 1770（1375,2175）ml,p<0.001].The cumulative fluid balance within 6 hours after operation was the highest in group A,the second in group B,and the least in group C[A vs B vs C:570（386,762）vs 153（-234,412）vs-336（-539,212）ml,p<0.001].The cumulative fluid balance within 24 hours after operation was the largest in group A,the second in group B,and the least in group C[723（337,1361）vs 574（-149,979）vs-523（-1069,202）ml,respectively,p<0.001].Correlation analysis showed that the cumulative intraoperative fluid balance was moderately correlated with CVP1（r=0.529,p<0.001）,but not with lactate and mean arterial pressure（p>0.05）.2.There was no significant difference in the overall incidence of postoperative complications among the three groups（A vs B vs C:30.6%vs 27.6%vs 36.7%,p=0.523）.The Pa O₂/Fi O₂ratio in group C was lower than that in group A and group B[A vs C:340（242,506）vs 257（234,339）mm Hg,p=0.001;B vs C:337（245,428）vs257（234,339）mm Hg,p=0.003].There was no significant difference in the duration of mechanical ventilation among the three groups[A vs B vs C:20（0,105）vs 48（5,175）vs78（0,139）hours,p=0.195].Group A and group C had a higher incidence of postoperative acute renal injury,while group B had the lowest incidence of postoperative acute renal injury（A vs B vs C:10.2%vs 4.1%vs 16.3%,p=0.040）.There was no significant difference in the duration of mechanical ventilation,length of stay in intensive care unit,total hospital stays,28-day mortality and other complications among the three groups（p>0.05）.3.The logistic regression analysis showed that CVP1 less than or equal to 12mm Hg is a protective factor for postoperative acute renal injury（OR=0.321,p=0.031）.4.In the subgroup analysis,the cumulative intraoperative fluid balance in group D was the least,followed by group E,and group F was the most[D vs E vs F:700（438,1119）vs 1070（900,1450）vs 1685（1363,2138）ml,p<0.001].The cumulative fluid balance within 6 hours after operation in group D was the largest,the second in group E,and the least in group F[D vs E vs F:585（417,764）vs 142（-277,368）vs-348（-491,15）ml,p<0.001].The cumulative fluid balance within 24 hours after operation in group D was the largest,the second in group E,and the least in group F[D vs E vs F:711（216,1345）vs 470（-210,967）vs-581（-1098,88）ml,p<0.001].In the comparison of postoperative complications,only 3 patients in group F（9.1%）suffered with acute heart failure（p=0.030）.The incidence of postoperative acute renal injury was the highest in group F,the second in group D and the lowest in group E（D vs E vs F:9.7%vs 6.3%vs 15.2%,p=0.388）.The postoperative Pa O₂/Fi O₂ratio in group F was lower than that in group D and E[D vs E vs F:420（245,502）vs 343（242,408）vs270（233,344）mm Hg,p=0.003].There was no significant difference in 28-day mortality,intensive care unit hospital stay,total hospital stays,mechanical ventilation duration and other postoperative complications among the three groups.Conclusions1.The cumulative fluid volume during operation was correlated with the increased CVP1.2.An abnormally high or low CVP1 may be a marker of increased incidence of renal failure.3.Excessive CVP1 may associate with impaired pulmonary function.4.Maintaining appropriate CVP1 within the range of 8-12mm Hg during perioperative period may reduce postoperative complication and benefit the patients.