Analysis Of The Reliability Of Central Venous Pressure And Stroke Volume Variation On The Volume Change During Cesarean Section With Dangerous Placenta Previa

ObjectiveTo analyze the hemodynamic changes during the cesarean section for parturients with dangerous placenta previa under general anesthesia and evaluate the reliability of central venous pressure(CVP)and stroke volume variation(SVV)in reflecting volume changes.Method48 parturients who underwent elective cesarean section under general anesthesia were included,with ASA grade ?,aged 28-40 years old.After the patients entered the operating room,electrocardiogram,pulse oxygen saturation,and non-invasive blood pressure were continuously monitored,and ringer's fluid was continuously infused at a speed of 10ml/kg/h.All patients were subjected to ultrasound-guided catheterization of the right internal jugular vein to monitor central venous pressure and left radial artery catheterization to monitor arterial blood pressure,and the FloTrac/Vigileo monitoring system was connected the arterial line to calculate patients' hemodynamic parameters.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),stroke volume(SV),stroke volume variability(SVV),Bispectral Index(BIS),and temperature were recorded at different time points respectively.BIS was maintained at 40-60,and the body temperature not lower than 36?.Intraoperative blood transfusion was carried out according to the guideline of massive blood loss management,and the rapid fluid infusion stopped when CVP reached 5 mmHg.After the operation,the ultrasound pulmonary edema evaluation was performed by anesthetist with more than three years echo experiences.At the same time,the agitation,delirium,nausea and vomiting of the patients were recorded.SPSS23.0 software was used for statistical analysis.The data were statistically described in the form of mean ± standard deviation.The comparison between different time points in the same group were conducted by paired data T-test.The correlations between two groups were calculated.The ROC curve was used to evaluate the reliability of SW in predicting blood volume change during hemorrhage,P<0.05 is regarded as statistically significant.Results1.Compared with T0,CVP was significantly higher at T1(P<0.05).2.Compared with T2.MAP and CVP were significantly lower at T3-T11,HR was significantly higher at T3-11(P<0.05).Compared with T2,SVV was significantly higher at T8-T11(P<0.05).Compared with T23 SV was significantly lower at T9-T11(P<0.05).3.Correlation analysis of hemodynamic parameters and hemorrhage:There are a negative correlation between MAP and hemorrhage(R=-0.7899,P<0.05),and a positive correlation between HR and hemorrhage(R=0.7828,P<0.05).A negative correlation between CVP and hemorrhage(R=-0.9063,P<0.05)and a positive correlation between SVV and hemorrhage(R=0.4382,P<0.05)were observed.A negative correlation between SV and hemorrhage(R=-0.3697,P<0.05)was confirmed.4.The ROC curve was used to evaluate the effectiveness of SVV in predicting blood volume change during hemorrhage,CVP of 3.75mmHg was used to assess whether the volume was insufficient.SVV predicts hemorrhage with a cutoff value of 7.5%,sensitivity of 65.4%,and specificity of 26.3%,and the area under the curve(95%confidence interval)was 0.744(0.694-0.793).5.All patients recovered successfully without obviously adverse events as delayed recovery,agitation,nausea,vomiting and pulmonary edema signs(P>0.05).6.The electrolyte and PH value varied in normal range,and hemoglobin was maintained more than 9g/L when the operation was over.7.The pathologic type of placenta was consistent with the preoperative ultrasound score.ConclusionDuring cesarean section for patients with dangerous placenta previa under general anesthesia,hemodynamics changes dramatically after large hemorrhage.The stroke volume variation changed into 7.5%when the hemorrhage was huge.Compared with stroke volume variation,there was a better correlation between central venous pressure and volume status,our study showed that continuous central venous pressure monitoring was better than the stroke volume variation in reflecting volume change during cesarean section with dangerous placenta previa.In summary,our research proved that central venous pressure was a timely and sensitive reflection on hemorrhage during cesarean section.