一项随机对照性研究,比较脉冲压变化 (PPV) 和变性指数 (PVI) 针对在进行内手术 (Supratentorial ICSOLs) 手术的患者中进行目标导向液体治疗
Pratyasa Nayak1, Subrata Kumar Singha1, Monica Khetrapal1
1Department of Anaesthesia, All India Institute of Medical Services - Raipur, Raipur, Chhattisgarh, India.
Romanian journal of anaesthesia and intensive care
|August 7, 2023
概括
使用Pleth变量指数 (PVI) 或脉冲压变量 (PPV) 的目标导向流体治疗 (GDFT) 在神经外科患者中没有显著差异. 这两种方法在指导流体管理方面都具有有限的准确性.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 神经外科 神经外科
背景情况:
- 术后流体管理仍然具有挑战性,特别是在神经外科手术中,由于尿剂的使用.
- 流体响应的动态参数,如GDFT,越来越多地使用,但它们在神经外科手术中的有效性尚未得到充分证实.
- 占用内空间的病变 (ICSOLs) 具有独特的流体管理考虑因素.
研究的目的:
- 为了比较Pleth变量指数 (PVI) 与脉冲压变量 (PPV) 在指导目标导向液体疗法 (GDFT) 在对 supratentorial ICSOLs的神经外科手术中的有效性.
- 评估PVI和PPV引导的GDFT对术后血清乳酸水平作为组织输液标记物的影响.
- 评估其他术后结局,包括输液,流血,CCU停留和并发症.
主要方法:
- 这是一项随机对照试验,涉及74名接受脑外科手术的患者.
- 患者被随机分配到PVI引导或PPV引导的GDFT组.
- 流体管理包括基线输液和额外的玻尿酸,由PVI (>15%) 或PPV (>13%) 值引发.
主要成果:
- 在PVI和PPV组之间没有观察到术后乳酸水平的显著差异 (P=0.18).
- 平均总液体输入量,血液流失,CCU停留,吐或低血压的发作也在两组之间没有显著差异.
- 在指导GDFT方面,PVI和PPV都表现出低的灵敏度和特异性,PVI的曲线下的面积为0.423,PPV的0.577.
结论:
- 在带有 supratentorial ICSOLs的神经外科患者中,PVI引导的GDFT在组织输液和术后并发症方面与PPV引导的GDFT相似.
- 无论是PVI还是PPV,在这个特定患者群体中准确指导GDFT方面都有局限性.
- 可能需要进一步的研究来完善复杂的神经外科病例中流体管理的动态参数.
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