Effect of goal-directed fluid therapy on hemodynamic and regional cerebral oxygen saturation in the elder patient undergoing one-lung ventilation / 临床麻醉学杂志

ABSTRACT

Objective To observe the effect of goal-directed fluid therapy on hemodynamic and regional cerebral oxygen saturation (rSO 2 )in the elder patient undergoing one-lung ventilation. Methods Fifty-eight patients scheduled for esophagus cancer resection(44 males,14 females,aged 65-79 years,ASA physical status Ⅱ or Ⅲ),were randomly divided into two groups (n =29 each)u-sing a random number table:conventional fluid therapy group (group C)and goal-directed fluid ther-apy group (group G).Implementing radial artery puncture and internal jugular vein puncture under local anesthesia in order to monitor BP and CVP.The Flotrac/Vigileo system was used to monitor cardiac output (CO),stroke volume variation (SVV)and cardiac index (CI)in the both group.As mentioned all above,group C received conventional fluid therapy based on MAP,CVP and urine vol-ume,whereas group G received goal-directed fluid therapy (GDFT)based on SVV with the goal of CI at 2.5-4.0 L·min-1·m-2 .Intraoperative continuous monitoring of rSO 2 was performed and the sur-gery rSO 2 average (rSO 2 ),the minimal surgery rSO 2 (rSO 2min )and the maximal percentage of the decreased rSO 2 compared to baseline values (rSO 2%max )were calculated in the both group.The varia-tion of MAP,HR,CVP,SVV and CI at the onset of the monitoring (T1 ),the momment before one-lung ventilation (T2 ),30 min after one-lung ventilation (T3 ),1 h after one-lung ventilation(T4 )and the end of the surgery (T5 )were recorded.The requirement for crystalloid and colloid,total volume of fluid infused,bleeding volume,urine volume,and requirement for vasoactive agents were recorded during operaton.Results Compared with group C,MAP at T3 ,T4 and CI at T3-T5 in group G were increased significantly,while CVP at T3-T5 and SVV at T2-T5 in group G were decreased (P <0.05). The rSO 2%max in group G was significantly lower than that in group C (P <0.05).No statistically sig-nificant difference was observed in the rSO 2 and rSO 2min between the two groups.Compared with group C,the requirement for crystalloid [(668±187)ml vs (1052±221)ml and total volume of fluid infused [(1212±318)ml vs (1519±329)ml],urine volume [(211±47)ml vs (278±54)ml]and vasoactive agents [4 cases (14%)vs 14 cases (48%)]were significantly decreased (P <0.05),the requirement for colloid were increased [(544±103)ml vs (467±94)ml,P <0.05].Conclusion The goal-directed fluid therapy based on SVV stabilizes the hemodynamic effectively,improves the CI and the perfusion of brain,and maintains the cereral oxygen metabolism in the elder patient undergoing one-lung ventilation.