Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study
Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study
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DOI：
10.1007/s10877-013-9461-6
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发表时间：
2013-06-01
影响因子：
2.2
通讯作者：
Marx, Gernot
中科院分区：
文献类型：
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作者：
Scheeren, Thomas W. L.;Wiesenack, Christoph;Marx, Gernot
围手术期血流动力学优化可改善接受高风险手术（HRS）的患者的术后结局。在这项前瞻性随机多中心研究中，我们研究了基于连续每搏输出量变异度（SVV）和每搏输出量（SV）监测的个体化目标导向液体管理对术后结局的影响。64例接受HRS的患者随机分为对照组（CON，n = 32）或目标导向组（GDT，n = 32）。在GDT中，连续监测SVV和SV（FloTrac/Vigileo），使患者达到并维持在Frank-Starling曲线的平台（SVV <10%，SV增加<10%，以响应液体负荷）。使用SOFA评分评估器官功能障碍，使用TISS评分评估资源利用。术后并发症随访28天。主要结局指标为并发症（感染、心脏、呼吸、肾脏、血液和腹部术后并发症）的数量、ICU住院期间的最大SOFA评分和累积TISS评分、机械通气持续时间、ICU住院时间和适合出院的时间。12例患者必须从最终分析中排除（每组6例）。在手术过程中，GDT比CON接受了更多的胶体（1，589 vs. 927 ml，P < 0.05），GDT的SVV降低（从9.0%降至8.0%，P < 0.05），但CON没有。GDT的术后伤口感染数量较低（0 vs. 7，P < 0.01）。尽管无统计学显著性，但至少发生1例并发症的患者比例（46 vs. 62%）、每例患者的术后并发症数量（0. 65 vs. 1. 40）、最大沙发评分（5. 9 vs. 7. 2）和累积TISS评分（69 vs. 83）倾向于较低。这项多中心研究表明，基于SVV和SV优化方案的液体管理是可行的，并减少了术后伤口感染。我们的研究结果还表明，目标导向的策略可能会减少术后器官功能障碍。
Perioperative hemodynamic optimisation improves postoperative outcome for patients undergoing high-risk surgery (HRS). In this prospective randomized multicentre study we studied the effects of an individualized, goal-directed fluid management based on continuous stroke volume variation (SVV) and stroke volume (SV) monitoring on postoperative outcomes. 64 patients undergoing HRS were randomized either to a control group (CON, n = 32) or a goal-directed group (GDT, n = 32). In GDT, SVV and SV were continuously monitored (FloTrac/Vigileo) and patients were brought to and maintained on the plateau of the Frank-Starling curve (SVV < 10 % and SV increase < 10 % in response to fluid loading). Organ dysfunction was assessed using the SOFA score and resource utilization using the TISS score. Patients were followed up to 28 days for postoperative complications. Main outcome measures were the number of complications (infectious, cardiac, respiratory, renal, hematologic and abdominal post-operative complications), maximum SOFA score and cumulative TISS score during ICU stay, duration of mechanical ventilation, length of ICU stay, and time until fit for discharge. 12 patients had to be excluded from final analysis (6 in each group). During surgery, GDT received more colloids than CON (1,589 vs. 927 ml, P < 0.05) and SVV decreased in GDT (from 9.0 to 8.0 %, P < 0.05) but not in CON. The number of postoperative wound infections was lower in GDT (0 vs. 7, P < 0.01). Although not statistically significant, the proportion of patients with at least one complication (46 vs. 62 %), the number of postoperative complications per patient (0.65 vs. 1.40), the maximum sofa score (5.9 vs. 7.2), and the cumulative TISS score (69 vs. 83) tended to be lower. This multicentre study shows that fluid management based on a SVV and SV optimisation protocol is feasible and decreases postoperative wound infections. Our findings also suggest that a goal-directed strategy might decrease postoperative organ dysfunction.