Comparsion of stroke volume variation with central venous pressure for guiding intraoperative fluid management in elderly patients undergoing gastrointestinal surgery

Abstract

Objective To investigate the applicability of stroke volume variation (SVV) as an index for guiding fluid management in gastrointestinal surgery in elderly patients and the effect of SVV-guided volume management on gastrointestinal functional recovery and postoperative outcome.Methods Forty ASA Ⅰ or Ⅱ elderly patients undergoing gastrointestinal surgery were randomized into two groups [group SVV and group central venous pressure (CVP),20 patients in each group].The patients in group SVV received fluid therapy with Hydroxyethyl Starch depending on SVV which was maintained＜10％ and kept CVP in normal range.The patients in group CVP received fluid therapy with Hydroxyethyl Starch depending on CVP which was maintained at 8 mmHg-12 mmHg (1 mmHg=0.133 kPa) and circulatory stability.All patients were given same anaesthesia protocol.Hemodynamic parameters were recorded at instant time before induction (T0),before intubation (T1),after intubation (T2),after the abdominal cavity opened (T3),after bowel anastomose (T4),after abdomen wall closure (T5).Duration of surgery,intravenous fluid volume,blood loss,urine output were also recorded.The laboratory data such as hemoglobin (Hb),hematocrit (Hct),creatinine,blood urea nitrogen were examined the day before and after surgery.The time of passing gas,liquid intake time after surgery,length of hospital stay was examined.Results Compared with group SVV,CVP in group CVP was higher at T5[(11.6±2.0) cmH2O(1 cmH2O=0.098 kPa),P＜0.05)],SVV was lower at T4,T5 [(4.5±1.5)％,(4.2±1.4)％,P＜0.05].No differences in mean artery pressure (MAP),heart rate (HR),cardiac output (CO),stroke volumn (SV) between groups were found (P＞0.05).Compared with T0,MAP,CO,SV in both groups were lower at T1[Group SVV:(74±13) mmHg,(3.7±1.0) L/min,(59±11) ml/b.Group CVP:(71±12) mmHg,(3.8±1.1) L/min,(58±13) ml/b](P＜0.05),HR in both groups was lower at T4 and T5 [Group SVV:(61±8),(61±9) bpm.Group CVP:(60±7),(61±9) bpm)](P＜0.05).The intraoperative intravenous fluid volume in group SVV [(2 560±462) ml] was less than in group CVP [(3 153±823) ml] (P＜0.05).Urine output showed no difference between groups (P＞0.05).Postoperative Hb,Hct were significantly lower than that in preoperative.Creatinine,blood urea nitrogen in group SVV did not differ between pospoperative and preoperative,while in group CVP,blood urea nitrogen [(4.0±2.0) mmol/L] is significant lower postoperatively than preoperatively (P＜0.05).The time of passing gas [(2.6±1.2) d] liquid intake time [(4.0±1.7) d] in group SVV were significant shorter than in group CVP (P＜0.05).The length of hospital stay did not differ between the two groups (P＞0.05).Conclusions Stroke volume variation could be used for guiding fluid management in elderly patients undergoing gastrointestinal surgery,which could reduce introperative fluid administration,result in more stable hemodynamic,improve postoperative outcomes. Key words: Stroke volume variation ; Central venous pressure ; Gastrointestinal surgery ; Fluid management ;