Effect Of Controlled Hypotensive Drugs On Predicting Transfusion Response By Stroke Volume Variability In Patients Undergoing Robotic Hepatobiliary Surgery

Research No.1 The effect of Urapidil on the threshold of stroke variability in patients undergoing robotic hepatobiliary surgeryObjective:To investigate the effect of Urapidil on the predictive accuracy and diagnostic threshold of stroke volume variation(SVV)in hypertensive and non-hypertensive patients undergoing robotic hepatobiliary surgery.Methods:Sixty-three patients undergoing robotic hepatobiliary surgery under general anesthesia were divided into hypertension group(25 cases)and non-hypertension group(38 cases)according to whether or not essential hypertension was present.The range of hypotension was 10%<SAP<20%,and ASAP=(SAP basis values-the target value of SAP)/SAP basic value 100%..Volume loading test was performed after artificial pneumoperitoneum(14mmHg)was established in reverse-Trendelenburg position.Hemodynamic indexes including heart rate(HR),arterial systolic pressure(SAP),cardiac output(CO),cardiac output index(CI),stroke volume(SV),stroke volume index(SVI)and SVV were recorded before and after infusion.Then the ROC curve of SVV was drawn to determine the accuracy and diagnosis of SVV in predicting volume status in hypertensive and non-hypertensive patients after anti-Trendelenburg posture and pneumoperitoneum.Results:In the patients with controlled hypotension using urapidil(pump speed 6-7 g/kg/min),the area under the ROC curve of SVV in hypertension group was 0.974,the diagnostic threshold was 13.5%,the ROC curve of SVV in non-hypertension group was 0.832,and the diagnostic threshold was 15.5%.Conclusion:SVV can accurately predict the volume status of patients in hypertension and non-hypertension groups after controlled hypotension with urapidil in the anti-Trendelenburg position and fixed pneumoperitoneal pressure,and the SVV diagnostic threshold in non-hypertensive patients is higher than that in hypertensive patients.Research No.2 Effect of different antihypertensive drugs on the prediction of the threshold of Infusion response in patients undergoing robotic hepatobiliary surgeryObjective:To evaluate the predictive value of stroke volume variation(SVV)on the infusion response accuracy and diagnostic threshold of controlled hypotension using two different antihypertensive drugs in patients undergoing hepatobiliary surgery.Methods:We reviewed the medical records of 59 patients who had robot hepato-biliary surgery under general anesthesia.There were 29 patients in(N)group,while 30 patients were in the(U)group,controlling decompression range of 10%<? SAP<20%,including? SAP=(SAP basis values-the target value of SAP)/SAP basic value 100%,in the reverse Trendelenburg position of artificial pneumoperitoneum(14mmHg)after the capacity load test,Heart rate(HR),systolic blood pressure(SAP),cardiac index(CI),stroke index(SVI)and SVV were documented and compared before and after infusion.SVI change(? SVI)>10%were defined as responsive,drawing SVV judgment expansion effect of the receiver-operating characteristic(ROC)curve,determine the robot in patients with liver and gallbladder surgery under the condition of reverse Trendelenburg position and pneumoperitoneum,after using different antihypertensive drugs SVV state prediction capacity threshold value and the accuracy of diagnosis.Results:In N group,the area under curve on ROC was 0.954,the diagnostic threshold was 13.5%.In U group the ROC area under curve on ROC was 0.765,and the diagnostic threshold was 15.5%.Conclusion:SVV can accurately predict the patien's volume status during the operation of robotic hepatobiliary surgery under the condition of reverse Trendelenburg position and fixed pneumoperitoneum pressure,but the diagnostic threshold for N and U were different.