The Application Of Goal-directed Fluid Restriction Based On Stroke Volume Variation And Cardiac Index During One-lung Ventilation In Thoracoscopic Lobectomy

Objective:To observe the application of goal-directed fluid restriction?GDFR?based on stroke volume variation?SVV?and cardiac index?CI?during one-lung ventilation?OLV?in thoracoscopic lobectomy.Methods:168 ASA physical status I or II patients of both sexes,aged 35 to 60 years,scheduled for thoracoscopic lobectomy under OLV were randomly divided into two groups?n=84 each?using a random number table:GDFR protocol?group G?or conventional fluid therapy groups?group C?.The patients were received a restricted diet before surgery,and the oxygen?2L/min?were inhaled by nasal catheter after enter into the operating room.Before the induction of anesthesia,the electrocardiogram?ECG?,blood pressure?BP?,central venous pressure?CVP?,pulse oxygen saturation?SpO₂?,temperature,and Narcotrend index?NTI?were continuously monitored,the standardized central venous and radial artery puncture was performed to monitor arterial blood pressure and CVP.The SVV and CI were measured by the FloTrac/Vigileo system.Patients in group C underwent conventional fluid therapy based on mean arterial pressure?MAP?,CVP,and urine volume in order to maintain MAP>65mmHg,CVP 6 to 12mmHg,and the urine output>0.5mL/kg/h,whereas those in group G received GDFR protocol associated with the stroke volume variation from 10 to 13%and the cardiac index was controlled at a minimum of 2.5 L/min/m².The volume of totally administered crystalloid and colloid,blood loss,urine volume,and the requirement for vasoactive agents was recorded and analyzed.The hemodynamic and lung mechanics parameters were recorded before OLV?T₀,baseline?,30 min?T₁?and60 min?T₂?after OLV,10 min after re-expansion?T₃?,and the end of the operation?T₄?.The radial arterial blood and central venous blood samples were collected for blood gas analysis at the above time point in order to measure the oxygen partial pressure?PaO₂?and carbon dioxide partial pressure?PaCO₂?,then the oxygenation index?OI?,alveolar to the arterial difference of oxygen tension?A-aDO₂?,respiratory index?RI?and Intrapulmonary shunt?Qs/Qt?of each patient was evaluated.The concentration of serum TNF-?,IL-6 and IL-10 were determined by ELISA at T₀,T₄,and 6h?T₅?,24h?T₆?,and 72?T₇?after the operation using venous blood samples.Results:Compared with T₀,the values of MAP at T₁ to T₃ and the values of CI at T₁ to T₄ were decreased significantly in group C?P<0.05?.In both group,the PH was decreased and PaCO₂ was increased significantly at T₁ to T₂?P<0.05?;the Ppeak,Pplat was increased and the Cdyn was decreased significantly at T₁ to T₃?P<0.05?;The OI was decreased and RI,A-aDO₂ was increased significantly at T₁ to T₄?P<0.05?;and the concentration of TNF-?,IL-6 and IL-10 at T₄ to T₇ was increased significantly?P<0.05?.Compared with group C,the requirement for crystalloid and total volume of fluid infused,and the bolus of noradrenaline usage were decreased significantly?P<0.05?;the Ppeak,Pplat was decreased and the Cdyn was increased significantly at T₁ to T₃ in group G?P<0.05?;the OI was increased and RI,A-aDO₂ was decreased significantly at T₁ to T₄ in group G?P<0.05?;the values of MAP at T₁ to T₂ and the values of CI at T₁to T₄ were increased significantly in group G?P<0.05?;the incidence of acute lung injury,pulmonary infection and nausea and vomiting were decreased significantly at in group G?P<0.05?.No statistically significant differences were observed in the concentrations of serum TNF-?,IL-6,and IL-10 between the two groups?P>0.05?.Conclusion:GDFR protocol based on SVV and CI applied to the patients undergoing OLV might improve the intraoperative pulmonary oxygenation and lung mechanics,stabilized hemodynamics,reduced the postoperative complications and the length of hospital stay.