| ObjectiveTo evaluate the effect of pulmonary lobectomy and lymph node dissection on hemodynamics and extravascular lung water monitored with Piccoplus monitor; To supply experience for the perioperative administration through the study to changes of hemodynamics and extravascular lung water during thoracic surgical procedures.Methods40 patients (28 males, 12 females) aged 41 to 70 years undergoing pulmonary lobectomy or radical correction of esophageal carcinoma were studied . Anesthesia was induced with sufentanil 0.5μg﹒ kg-1, midazolam 0.1~0.2mg﹒ kg-1, TCI propofol 4ug﹒ ml-1(Cp), rocuronium 0.6～1.2mg﹒ kg-1 and maintained with inhalation of 50﹪nitrous oxide in oxygen, TCI propofol and intermittent iv boluses of sufentanil and vecuronium. Hemodynamic and extravascular lung water parameters were monitored with Piccoplus monitor and respectively recorded at pre-anesthesia(T1),10min after anesthesia (T2),15min after thoracotomy and one-lung ventilation(T3),pulmonary lobectomy(T4),10min after thorax was being closed and two-lung ventilation(T5),15min after extubation(T6),eight hours after operation(T7), twenty-four hours after operation(T8),forty-eight hours after operation(T9) . Hemodynamic parameters include mean arterial pressure(MAP), heart rate(HR), cardiac output index(CI), stroke volume index(SVI), pulmonary vascular permeability index(PVPI), global end-diastolic volume index(GEDI),intrathoracic blood volume index(ITBI),cardiac function index(CFI) and systemic vascular resistance index(SVRI). Gelofusine was infused within 20~30 min after hemodynamic parameters were measured at T8. Hemodynamic parameters were recorded in 10 min after Gelofusine was infused. ResultsThe extravascular lung water had not marked change in the patients of lung cancer or esophageal carcinoma during the perioperative period. CI during anesthesia was decreased significantly than pre-operation and post-operation. CFI was increased significantly at T4 and T6. GEDI and ITBI had a temporal depress at T2 and T3. GEF was decreased at T4 and after operation. PVPI stepped up at T2 and T3. SVRI was increased after pulmonary lobectomy and recoveried after operation. MAP had a slight depress during anesthesia and increased at T6. HR had the same variance as MAP. GEDI and ITBI had significant correlation to CI and SVI. The coefficient correlation of CI to GEDI and ITBI were 0.849(p<0.01), 0.805(p<0.01) respectively. The coefficient correlation of SVI to GEDI and ITBI were 0.809(p<0.01), 0.720(p<0.01) respectively. However, There were no correlation between CVP and CI, SVI. The coefficient correlation of CVP to CI and SVI were 0.003(p=0.994), 0.339(p=0.34) respectively. HR,SVRI degraded slightly and MAP,GEDI,ITBI,CI,SVI,CVP increased in different level after Gelofusine was infused. A significant correlation were shown between changes of ITBI,GEDI and changes of SVI. The coefficient correlation were 0.59(p<0.05), 0.67(p<0.05) respectively.ConclusionsAmong patients undergoing pulmonary lobectomy or radical correction of esophageal carcinoma, there was no significant variance in extravascular lung water. Fluid restriction may lead to the instability of hemodynamics during the perioperative period .GEDI and ITBI are more useful than CVP in fluid management during the perioperative period as an indicator reflecting preload.
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