The Efficacy Of Different Fluid Therapy To Cardiac Function Indexes And Blood Pressure In Patients Receiving PCNL Under General Anesthesia:A Clinical Study

Background:Percutaneous nephrolithotripsy（PCNL）is the major surgical procedure for patients undergoing renal calculi surgery.Due to the influence of body position,bleeding,infection,large circulatory fluctuations often occur during PCNL treatment under general tracheal anesthesia,which mainly manifested as decreased blood pressure.However,current monitoring of perioperative hemodynamic changes in PCNL is mainly limited to blood pressure and heart rate.This most basic means of circulatory monitoring can only be detected when the patient has developed hypotension or even severe hypotension.At this time,the patient is likely to have developed circulatory failure;no early warning can be given before the occurrence of hypotension,and intervention measures can be taken in advance to avoid the occurrence of severe hypotension.Real-time monitoring of perioperative cardiac function indicators shows a trend from invasive to minimally invasive to noninvasive^[1].In this study,we will evaluate the changes of systolic blood pressure（SBP）,diastolic blood pressure（DBP）,non-invasive cardiac output（CO）,stroke volume（SV）,peripheral vascular resistance（SVR）,pulse variation（PPV）and other circulatory parameters in PCNL patients under open and restrictive fluid replacement in combination with T Line non-invasive real-time arterial blood pressure and hemodynamic monitoring system（T-Line Non-Invasive Continuous Artery Blood Pressure And Hemondynamics Measurement,TL-400）to investigate the relationship between CO,SV,SVR,PPV and SBP and DBP during PCNL.Objective:To evaluate the changes of SBP,DBP,CO,SV,SVR,PPV and other circulatory parameters in patients with PCNL under open and restrictive fluid replacement using TL-400,and to investigate the relationship between CO,SV,SVR,PPV and SBP,DBP during PCNL.Methods:78 patients（ASA I-II）with PCNL under general anesthesia with endotracheal intubation were screened according to the screening criteria.Finally,57 patients were randomly divided into open fluid replacement group（group A,n=25）and restrictive fluid replacement group（group B,n=32）,of which 7 patients in group B developed severe hypotension after prone position and terminated restrictive fluid replacement.Spontaneous breathing in awake state（T₀）,mechanical ventilation 15 min in supine position（T₁）,mechanical ventilation 30 min in supine position（T₂）,mechanical ventilation in prone position 15 min（T₃）,mechanical ventilation in prone position 30min（T₄）,and mechanical ventilation in prone position 45 min（T₅）were monitored and collected,respectively:（1）Cuff systolic blood pressure（SBP）Cuff diastolic blood pressure（DBP）（5 minutes ipsilateral to T-LINE noninvasive real-time arterial blood pressure and hemodynamic monitoring system）,SPO₂,Pet CO₂;（2）continuous noninvasive systolic blood pressure（SBP）,continuous noninvasive diastolic blood pressure（DBP）,heart rate（HR）,Cardiac output（CO）,stroke volume（SV）,peripheral vascular resistance（SVR）,pulse pressure variability（PPV）;（3）Blood gas analysis,BIS and lactic acid,and the total infusion volume of the patients was counted.SPSS22.0 software package was used for statistical analysis,and P<0.05 was considered statistically significant.Results:1.Comparison of hemodynamic parameters between group A and group B at the same time points:（1）A group at T₀cuff SBP,cuff DBP,continuous SBP,continuous DBP,HR,CO,SV,SVR and PPV showed no statistical difference compared with B group（P>0.05）;（2）T₅cuff SBP and continuous non-invasive SBP in group A were higher than B group（P<0.05）.There were no statistically significant differences in cuff SBP,cuff DBP,continuous SBP,continuous DBP,HR between the two groups at other time points（P>0.05）;（3）CO in group A was higher than that in group B at T₁and T_3-5,SV in group T_1-5was higher than that in group B,and SVR in group T₄and T₅was lower than that in group B.PPV was significantly lower in T_2-5than in group B（P<0.05）.2.Comparison between patients in group A or group B at different time points:（1）SBP and DBP of T_1-5cuff in groups A and B were significantly lower than those of T₀（P<0.05）;（2）CO of T_4-5in groups A and B was significantly lower than that of T_0-2,and the overall trend of CO in the two groups was statistically significant（P<0.05）;（3）T_3-5SV in groups A and B was lower than that of T₁,Group A T_3-5SV vs T₂No statistical difference（P>0.05）,T_1-2SV in group B was significantly lower than T0,T_3-5SV was significantly lower than T_0-2（P<0.05）.The overall trend of SV in the two groups showed statistical significance（P<0.05）;（4）T_1-2SVR in groups A and B was significantly lower than T₀.while T_3-5was significantly higher than T₁（P<0.05）.T_3-5SVR in group B was significantly higher than T_1-2,and T₅was higher than T_3-4（P<0.05）.The overall trend of SVR in the two groups was significant（P<0.05）;5 PPV in group B was higher than that in group T_0-2at T_3-5,and PPV in group B tended to gradually increase before prone position,T₂was significantly higher than that in T₁,while T₅was lower than that in T₄（P<0.05）,and the overall trend of PPV in the two groups was statistically significant（P<0.05）.3.The incidence of IOH in group A was significantly lower than that in group B（P<0.05）.4.Compared with blood gas analysis and Lac indexes in group A and group B,（1）Hct at T₆in group A and group B was significantly lower than that at T₀,P<0.05;（2）Lac at T₆in group A was significantly lower than that at T₀,P<0.05.Conclusions:The sensitivity of CO,SV,and SVR PPV to volume was better than that of SBP and DBP in patients receiving PCNL under general anesthesia.Appropriate volume supplementation reduced the incidence of hypotension during PCNL.