Comparison Of Volume Assessment Methods Intransurethral Resection Of Prostate

OBJECTIVE:To compare the value of ultrasonographic measurement of inferior vena cava respiratory variability,pleural fluid level in CSM3000 non-invasive blood flow testing system,and central venous pressure in assessing whole-body volume status in patients undergoing transurethral resection of prostate.METHODS:A total of 80 male patients aged 60-75 years,ASA grade II-III,and anesthesia were selected for tracheal intubation.anesthesia.All patients underwent right subclavian central venous catheterization and radial artery catheterization within local anesthesia.ECG,invasive blood pressure,SpO₂ and bispectral index?BIS?were monitored.Before induction of anesthesia,compensatory volume expansion was performed with sodium lactate Ringer's solution at 6 ml/kg,and infusion was completed within 30 min.HR,MAP and CVP were recorded before and after expansion,and patients were collected using Flotrac/Vigileo hemodynamic monitoring system.Cardiac output,stroke volume,stroke index,non-invasive blood flow detection system monitor and record pleural fluid level,and supine position ultrasound to measure the inspiratory and end-expiratory inferior vena cava diameter of the patient during spontaneous breathing?Inferior vena cava?Diameter,IVCD),calculate the IVC variation of the inferior vena cava.After general anesthesia induction,tracheal intubation was used to control ventilation.During the operation,propofol and remifentanil were continuously pumped to maintain anesthesia,and propofol dose was adjusted according to BIS.The above indicators were monitored every 15 minutes after the start of surgery until the 15 min acquisition time point after the end of the operation.The ROC curve was used to evaluate the volume reactivity of elderly patients with IVC variation and CVP.The correlation between intraoperative inferior vena cava IVC variation,pleural fluid TFC,CVP and stroke volume index?SVI?was analyzed by Pearson correlation test.result:1.After volume expansion,MAP?70.24±8.15 VS 78.52±10.18?,CVP?5.37±0.46VS 6.78±0.39?,CO?4.27±0.28 VS 5.12±0.25?,SV?52.44±8.52 VS 68.57±7.63?and SVI?33.27±5.73 VS 39.8±3.84?all significantly increased,IVC variation?44.37±15.64 VS 24.48±12.16?decreased,while HR and TFC were not significantly different before and after expansion.2.The ROC curve evaluates the effectiveness of CVP and IVC variation in predicting liquid reactivity.IVC variation predicts a critical value of liquid reactivity of 0.44?sensitivity 70.83%,specificity 87.5%?,and CVP predicts the critical value of liquid reactivity.6.2 mmHg?sensitivity 87.0%,specificity 37.5%?.TFC predicts a critical value of liquid reactivity of 0.52 1/??sensitivity 17.3%,specificity 12.5%?.The area under the curve?AUC?of IVC variation was 0.82?P<0.01;95%CI,0.74-0.96,P=0.000?,and the area under the curve?AUC?of CVP variation was 0.61?P=0.16;95%CI,0.47?.-0.86,P=0.183).The area under the TFC curve?AUC?was0.45?P=0.28?,and 95%CI was meaningless.3.After the start of surgery,in the case of mechanical ventilation,there was a significant negative correlation between the increase of IVC variation and SVI?r1=-0.674,r2=-0.715,r3=-0.693,r4=-0.624,r5=-0.741,r6=-0.686,r7=-0.662,r8=-0.574,r9=-0.618,Table 6-3?.The correlation between?35?CVP and?35?SVI is general?r1=0.425,r2=0.393,r3=0.452,r4=0.418,r5=-0.442,r6=0.527,r7=-0.483,r8=0.561,r9=0.450,Table 6-4?.The correlation between TFC and SVI is almost zero.4,TURP intraoperative lavage fluid absorption changes are most likely to reach the peak period,the correlation of IVC variation is significantly higher than CVP and TFC.Conclusion:IVC variation can be used to assess the volume status and volume responsiveness of patients before induction of general anesthesia.IVC variation can be used to guide infusion therapy.There is a certain degree of negative correlation between IVC variation and volume status.It has a certain guiding significance for evaluating the high volume status of prostate surgery.CVP has a general correlation with volume status.It is not recommended as the first choice for capacity monitoring,TFC monitoring indicator of the non-invasive blood flow testing system has no significant significance in evaluating the state of the volume in such surgery.