The Guiding Significance Of PVI In The Restrictive Fluid Challenge Of Upper Gastrointestinal Hemorrhage

Background:Upper gastrointestinal bleeding is a common emergent emergency.The hemorrhagic shock caused by massive hemorrhage has a high mortality rate.Rapid replenishment of cirrhosis and elderly patients can not only lead to rebleeding,but also lead to pulmonary edema,heart failure,decreased oxygenation capacity of the body,accumulation of lactic acid,and eventually death of the patient.In the case of bleeding in patients with upper gastrointestinal bleeding and hemorrhagic shock,restrictive fluid resuscitation can effectively improve tissue and organ perfusion and oxygen supply in patients with hemorrhagic shock,and it will not excessively dilute the blood and better protect the formed thrombus and reduce it.The risk of rebleeding can improve the prognosis of patients and significantly reduce the mortality rate.Therefore,the convenient,fast,accurate and non-invasive hemodynamic detection is particularly important for the guidance of emergency fluid-limited resuscitation.Pleth variability index(PVI)has continuous,dynamic and non-invasive characteristics,and has good correlation with SVV,PPV,CVP,and so on.The purpose of this study was to investigate the significance of PVI in the guidance of restrictive fluid resuscitation in upper gastrointestinal hemorrhagic shock.Objectives:To investigate the predictive value and guiding significance of pleth variation index(PVI)for restrictive fluid resuscitation in patients withupper gastrointestinal hemorrhagic hemorrhagic shock and to provide reference for target-oriented liquid management in fluid resuscitation.Methods:Seventy-five patients with acute upper gastrointestinal hemorrhage and hemorrhagic shock admitted to the emergency room were divided into two groups: conventional fluid resuscitation(group A)and restrictive fluid resuscitation.The restrictive fluid resuscitation was divided into CVP group(Group B)and PVI group(group C),of which 27 in group A,23 in group B and 25 in group C.The total amount of resuscitation fluid,12 h mean arterial pressure(MAP),lactate(Lac),basic excess(BE),platelet count(PLT),hemoglobin(HGB)and 48 h prothrombin time(PT)Rate,mortality and multiple organ dysfunction syndrome(MODS)incidence,statistical analysis of the results.Results:1.The total fluid and mean arterial pressure in conventional liquid resuscitation group(group A)were significantly more than those in the restricted liquid resuscitation group(group B and group C);and the CVP group(group B)mean arterial pressure was higher than that of PVI group(group C);the difference was statistically significant(P <0.05).2.Comparison of lactic acid at 12 h and 24 h after fluid resuscitation in patients with upper gastrointestinal hemorrhagic shock and hemorrhagic shock.The results showed that there was no significant decrease in lactate value before and 12 h and 24 h in the conventional rehydration group(group A).In the resuscitation group,the lactate values of the CVP-guided group(B group)and the PVI-guided group(C group)at 12 h and 24 h were significantly lower than before treatment,P<0.05;and both were significantly lower than those of the conventionalrehydration group(group A).<0.05.In addition,lactate levels at 12 h and24h in the PVI-guided group(C group)were significantly lower than those in the CVP-guided group(group B),P<0.05.3.The residual value of the Buffue excess at 12 h and 24 h after fluid resuscitation in each group of patients with upper gastrointestinal hemorrhagic shock and hemorrhagic shock was compared.The results showed that there was no significant decrease in the baseline residual value in the conventional rehydration group(group A)before treatment,12 h,and 24h;In the restrictive fluid resuscitation group,the baseline residual values of the CVP-guided group(group B)and the PVI-guided group(group C)at 12 h and 24 h were significantly lower than before treatment,P<0.05;and both groups were significantly lower than the conventional fluid replacement group(Group A),P<0.05;In addition,the remaining values of the base 12 h and 24 h in the PVI-guided group(C)were significantly lower than those in the CVP-guided group(B),P<0.05.4.The platelet count and hemoglobin in the conventional liquid resuscitation group(group A)were lower than those in the two groups(group B and group C),and PT longer than those in the two groups(group B and C)The PVI-guided group(group C)had higher platelet count and hemoglobin content than the CVP-guided group(group B).The differences were statistically significant(P <0.05).5.The rebleeding rate,MODS morbidity and mortality in routine liquid resuscitation group(group A)were higher than those in the restricted liquid resuscitation group(group B and group C),The differences were statistically significant(P <0.05).The PVI-guided group(C)rebleeding rate,MODS incidence and mortality were higher than CVP-guided group(B);but no significant difference(P> 0.05).Conclusions:1.In the upper gastrointestinal hemorrhagic shock with CVP and PVI for the guidance of restrictive fluid resuscitation can effectively reduce the total amount of fluid resuscitation and blood transfusion,maintain MAP at a low effective level;and compared with CVP,PVI can be more Effectively limit the total amount of liquid,blood transfusion volume and MAP value.2.Restricted fluid resuscitation in patients with upper gastrointestinal hemorrhagic shock following PVI guidance can effectively maintain platelet(Plt)and hemoglobin(HGB)values and significantly reduce lactate(Lac)and base excess(BE)levels.3.The limited fluid resuscitation guided by PVI and CVP can effectively reduce the incidence of rebleeding after 48 hours,reduce the incidence of complications and mortality,and improve the prognosis of patients.