The Clinical Research Of Goal-directed Fluid Management Based On The FloTrac/Vigileo In Thoracic Lobectomy

Objective:FloTrac/Vigileo system,TEE,and central venous pressure were used to guide intraoperative fluid management in patients undergoing single-lung pneumonic ventilation surgery.The feasibility of FloTrac/Vigileo system in single-lung pneumonic ventilation surgery was investigated by comparing the correlation between hemodynamic indicators and postoperative pulmonary function status in each group.Methods:Selected from August 2017 to August 2019,111 patients with single lung ventilation thoracic surgery（radical resection of lung cancer,radical resection of esophageal cancer,lobectomy,etc.）were selected in our hospital,grade ASAⅠ-Ⅱ,body mass index（BMI）At 18～25kg/m2,aged 18～66 years,the patients were divided into FloTrac/Vigileo group（FV group）,TEE group（T group）,central venous pressure group（V group）,37 each For example,record the patient’s pre-thoracic（T1）,single-lung ventilation（T2）,single-lung ventilation 15min（T3）,single-lung ventilation 30min（T4）,single-lung ventilation 60min（T5）after routine induction anesthesia Heart rate（HR）,mean arterial pressure（MAP）,central venous pressure（CVP）,fluid input and output,cardiac output,stroke volume variability（SVV）,stroke volume（SV）,inferior cavity the rate of venous collapse（cIVC） and T1 and T5,after operation with supine double lung ventilation for 10min（T6） were the arterial carbon dioxide partial pressure,oxygenation index（OI）,arterial oxygen partial pressure and alveolar-arterial oxygen partial pressure difference（A-aDO₂）.Results:1.There were no significant differences among the three groups in gender,operation time,average weight,body surface area,average height,average age and BMI（P>0.05）.2.At time point of T1-T6,there was no statistically significant difference in HR and MAP between the three groups（P>0.05）,at time point T2-T6,patients in F group and T group had lower CVP than those in C group,but the difference was not statistically significant（P>0.05）.3.There was no statistically significant difference between SV and CO at each time point in FV group and T group（P>0.05）.4.The overall correlation analysis of SV in group F and group T showed positive correlation,with correlation coefficient r=0.83 and P<0.01 correlation analysis was conducted on the whole CO of FV group and T group,and the results were positively correlated,with correlation coefficient r=0.91,P<0.01.5.The overall correlation between SVV and c IVC in group F and group T was analyzed,and the results were positively correlated,with correlation coefficient r=0.81,and P<0.01;The linear regression equation of SVV and c IVC was obtained,c IVC=17.89+2.76SVV,and the regression coefficient b=2.88.The regression analysis results showed that the difference was statistically significant（P<0.05）.6.The correlation analysis of SV,CO,SVV and c IVC in group F and group T at each time point showed that the hemodynamic parameters of the three groups were positively correlated at each time point from T2 to T5,and the differences were statistically significant（P<0.05）.However,the hemodynamic parameters of the three groups were not correlated at T1 and T6,and the differences were not statistically significant（P>0.05）.7.There was no statistically significant difference between the three groups OI,PaO₂,PaCO₂and A-aDO₂at each time point（P>0.05）;OI and PaO₂in each group were significantly lower than T1 at T5,and A-a DO₂in each group was significantly higher at T5 than at T1（P<0.05）;At T6,OI and PaO₂ in the three groups increased significantly compared with T5 but were still lower than T1,while A-aDO₂decreased significantly but was still higher than T1（P<0.05）;There was no statistical significance in the intra-group comparison between the three groups at different PaCO₂ moments（P>0.05）.8.There was no statistically significant difference in fluid output between the three groups after operation（P>0.05）,the input amount of group F and group T was lower than that of group C,but the difference was not statistically significant（P>0.05）.Conclusion:1.The FloTrac/Vigileo system,like TEE,is suitable for monitoring hemodynamic monitoring of thoracic single lung ventilation surgery and guiding intraoperative fluid management.2.The FloTrac/Vigileo system has certain advantages over conventional volume monitoring methods in improving postoperative lung function.