The Clinical Observation Of Comparison Of Stroke Volume Variation And Central Venous Pressure In Guiding Intraoperative Fluid Management Of Renal Transplantation

Objective To investigate the possibility of SVV in guiding intraoperative fluid management of renal transplantation.Methods 30 recipients of relational renal transplantation were randomly divided into two groups.One is G_SVV(n=15),another is G_CVP(n=15).The patients in G_SVV received fluid therapy depending on SVV,and maintained SVV＜10%,CVP was in normal range,and circulatory stability.When SVV＞10%,polygeline was given,and the infusion speed was accelerated.The patients in G_CVP received fluid therapy depending on CVP,and maintained CVP8～12mmHg and circulatory stability.When CVP＜8mmHg,the treatment above was performed.All patients were given the same anaesthesia proposal.To record SVV(G_SVV),SVI(G_SVV),CVP,MAP,HR at T0(after mechanical ventilation 15min),T1(after mechanical ventilation 45 min), T2(10 min before kidney reperfusion),T3(time of kidney reperfusion), T4(5 min after kidney reperfusion),T5(30 min after kidney reperfusion), T6(the end of operation).To record warm and cold ischemia time,time of seeing urine, duration of operation,urine volume after operation and 24 hours latter, nausea and vomiting,return of gastrointestinal function,postoperative complications,ICU stay,postoperative hospital stay.The blood sample of donors before operation,and blood sample of recipients before operation,end of operation,24 hours after operation was collected,and Cys C was tested with ELISA.Results One patient in G_SVV was excluded from this study,because of postoperative bleeding.①There is no significant difference between two groups in sex,age,BMI(P＞0.5).②There is no significant difference between two groups in MAP,CVP,HR at T0,T1,T2,T3,T4,T5 and in MAP,HR at T6;CVP_Gsvv(8.6±1.8)mmHg is less than CVP_Gcvp(9.9±1.5)mmHg at T6(P＜0.05).③There is no significant difference in intraoperative bleeding volume(p＞0.05),but fluid volume in G_SVV(2429.29±568.20)ml is less than G_CVP(2898.00±626.60)ml (P＜0.05).④There is no significant difference between two groups in warm and cold ischemia time,time of seeing urine,duration of operation, urine volume after operation and 24 hours latter,nausea and vomiting, return of gastrointestinal function,postoperative complications,ICU stay, postoperative hospital stay(p＞0.05).⑤In G_SVV,7 patients' SVV_T0＞10% (14.6%±1.9%),after volume expansion,all SVV_T1＜10%(7.4%±1.9%),△SVV 7.3%±1.7%,SVI accompanyingly increased,△SVI%(28.5%±12.8%),4 patients in these,△SVI%＞25%.Pearson correlations between SVV and△SVI%for above 7 patients,r=0.6(P＜0.05).For 4 patients of△SVI%＞25%,CVP also increased,△CVP 3.3±1.0mmHg.Conclusion Compare with CVP,SVV can more accurately reflect circulatory volume status and predict fluid responsiveness of renal transplantation patients;SVV can reduce intraoperative fluid volume for renal transplantation patients.