Effect Of Goal-directed Hemodynamic Management Strategy Combined With RSO₂ And BIS To Reduce Postoperative Acute Renal Injury After Valve Replacement

Objective To to investigate the effect of goal-oriented hemodynamic management combined with rSO₂ and BIS on the occurrence of acute renal injury in patients undergoing cardiac valve replacement.Methods 238 patients of both sexes,aged from 18 to 75 years,weighing 45 t o 95 kg,ASA III or IV,NYHG II or III,undergoing cardiopulmonary bypass f or cardiac valve replacement was randomly assigned into experience group（G roup C,n=122）and multimodal group（Group M,n=116）using a random num ber table.After admission to the operation room,in Group C,ECG,SPO₂,inv asive BP,CVP and PetCO2were routinely monitored.Patients in group M were m onitored on the basis of group C monitoring r SO₂ and BIS,and goal-directed regulatio n of hemodynamics was used.rSO2 was maintained not less than 20%of the ba se value or absolute value of not less than 55%;BIS was maintained between45 and 55;MAP was maintained the base value of±20%;SVI>25ml/m² an d CI>2.5 L·min^-1·m^-2;in special cases not lower than the pre-induced base val ue.The incidence of AKI was evaluated by KDIGO（improving global prognos is of nephropathy）.General data of patients were recorded including Intra-operativ e cardiopulmonary bypass time,aortic occlusion time,blood transfusion,infusio n,hemodynamic and other data.Besides,the postoperative incidence of AKI in48 hours,extubation time,ICU time,hospitalization stay,30-day mortality,an d other major complications were recorded.Results There is no statistically significant difference between the two groups of patients with general information.C group with the incidence of AKI was 41.8%compared with M group,the incidence rate of AKI was 24.6%,;extubation time,ICU residence time and hospitalization time were reduced,the over-all postoperative complications（P<0.05）,30-day postoperative mortality had no significant difference（P>0.05）.Conclusion A multi-mode monitoring management strategy based on rSO₂,BIS,and target directed hemodynamic management is beneficial to reduce the incidence of AKI,reduce the mechanical ventilation time,ICU residence time,hospitalization time and postoperative complications in patients undergoing cardiac valve replacement.