Clinical Study Of Volume Management Guided By Pleth Variability Index In Patients Undergoing Craniotomy

Objective To observe the effect of fluid management using pleth variability index(PVI)during craniotomy.Methods Seventy-six patients with intracranial tumor scheduled for craniotomy were assigned randomly divided into PVI-directed fluid management group(PVI group,n=38)and control group(CON group,n=38).Two groups were received lactated Ringer's solution 6 ~ 8 ml ? kg-1 during the anesthesia induction.After induction,lactated Ringer's solution were infused at a rate of 2 ml?kg-1?h-1 in PVI group.If PVI>14% more than 5 minutes,3 ml?kg-1 hydroxyethyl starch(6% HES)were infused rapidly.After induction,lactated Ringer's solution were infused at a rate of 4 ~ 6ml ? kg-1 ? h-1 in CON group.When MAP was less than 65 mm Hg,100~250 ml hydroxyethyl starch(6% HES)were infused rapidly.The liquid infusion,urine output,bleeding,time of operation,anesthsic time and blood gas analysis were recorded before induction(T0),before surgery(T1),removing the tumor(T2),end of the surgery(T3),respectively.The complications and recovery conditions were followed-up on the first,second,third,seventh and thirtieth postoperative day.Results There were no significant diffenrence in the situations between the two groups(P>0.05.Compared with CON group,the crystalloid infusion and the whole transfusion volume were significantly lower in PVI Group,colloidal liquid infusion was significantly higher in PVI Group(P<0.05).There were no significantly differences in blood gas analysis(Lac,p H,Glu,BE)at four times points between the two groups(P > 0.05).Compared with CON Group,postoperative facial edema,postoperative defecation time and postoperative hospital stay were significantly lower in PVI Group(P<0.05).Conclusion 1,Goal-directed fluid therapy which is based on PVI can reduce the total infusion volume during craniotomy operation and optimize fluid infusion.2,Goal-directed fluid therapy which is based on PVI during craniotomy operation can reduce the incidence of postoperative complications and improve postoperative recovery in patients undergoing craniotomy.