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Abstract：
BACKGROUND: Obesity increases the risk of morbidity and mortality during surgical procedures. Goal-directed fluid therapy (GDFT) is a new concept for perioperative fluid management that has been shown to improve patient prognosis. This study aimed to investigate the role of the Pleth Variability Index (PVI), systolic pressure variation (SPV), and pulse pressure variation (PPV) in maintaining tissue perfusion and renal function during GDFT management in patients undergoing laparoscopic sleeve gastrectomy (LSG).
METHODS: Two hundred ten patients were enrolled in our prospective randomized controlled clinical trial. Demographic data, hemodynamic parameters, biochemical parameters, the amount of crystalloid and colloid fluid administered intraoperatively, and the technique of goal-directed fluid management used were recorded. Patients were randomly divided into three groups: PVI (n = 70), PPV (n = 70), and SPV (n = 70), according to the technique of goal-directed fluid management. Postoperative nausea and vomiting, time of return of bowel movement, and hospital stay duration were recorded.
RESULTS: There was no statistically significant difference between the number of crystalloids administered in all three groups. However, the amount of colloid administered was statistically significantly lower in the SPV group than in the PVI group, and there was no significant difference in the other groups. Statistically, there was no significant difference between the groups in plasma lactate, blood urea, and creatinine levels.
CONCLUSIONS: In LSG, dynamic measurement techniques such as PVI, SPV, and PPV can be used in patients with morbid obesity without causing intraoperative and postoperative complications. PVI may be preferred over other invasive methods because it is noninvasive.
METHODS: Two hundred ten patients were enrolled in our prospective randomized controlled clinical trial. Demographic data, hemodynamic parameters, biochemical parameters, the amount of crystalloid and colloid fluid administered intraoperatively, and the technique of goal-directed fluid management used were recorded. Patients were randomly divided into three groups: PVI (n = 70), PPV (n = 70), and SPV (n = 70), according to the technique of goal-directed fluid management. Postoperative nausea and vomiting, time of return of bowel movement, and hospital stay duration were recorded.
RESULTS: There was no statistically significant difference between the number of crystalloids administered in all three groups. However, the amount of colloid administered was statistically significantly lower in the SPV group than in the PVI group, and there was no significant difference in the other groups. Statistically, there was no significant difference between the groups in plasma lactate, blood urea, and creatinine levels.
CONCLUSIONS: In LSG, dynamic measurement techniques such as PVI, SPV, and PPV can be used in patients with morbid obesity without causing intraoperative and postoperative complications. PVI may be preferred over other invasive methods because it is noninvasive.
摘要：
背景：肥胖会增加外科手术过程中的发病率和死亡率。目标导向液体治疗（GDFT）是围手术期液体管理的新概念，已被证明可以改善患者预后。本研究旨在探讨Pleth变异性指数(PVI)的作用，收缩压变异（SPV），腹腔镜袖状胃切除术（LSG）患者在GDFT管理期间维持组织灌注和肾功能的脉压变化（PPV）。
方法：我们的前瞻性随机对照临床试验纳入了210例患者。人口统计数据,血液动力学参数,生化参数，术中施用的晶体液和胶体液的量，并记录所使用的目标导向液体管理技术.患者随机分为三组：PVI（n=70），PPV（n=70），和SPV(n=70)，根据目标导向的流体管理技术。术后恶心呕吐,肠道运动恢复的时间，并记录住院时间。
结果：在所有三组中施用的晶体数量之间没有统计学上的显着差异。然而,SPV组的胶体给药量明显低于PVI组，而其他各组间差异无统计学意义。统计上,两组之间的血浆乳酸没有显着差异，血尿素,和肌酐水平。
结论：在LSG中，动态测量技术，如PVI，SPV,PPV可用于病态肥胖患者，不会引起术中和术后并发症。PVI可能优于其他侵入性方法，因为它是非侵入性的。
方法：我们的前瞻性随机对照临床试验纳入了210例患者。人口统计数据,血液动力学参数,生化参数，术中施用的晶体液和胶体液的量，并记录所使用的目标导向液体管理技术.患者随机分为三组：PVI（n=70），PPV（n=70），和SPV(n=70)，根据目标导向的流体管理技术。术后恶心呕吐,肠道运动恢复的时间，并记录住院时间。
结果：在所有三组中施用的晶体数量之间没有统计学上的显着差异。然而,SPV组的胶体给药量明显低于PVI组，而其他各组间差异无统计学意义。统计上,两组之间的血浆乳酸没有显着差异，血尿素,和肌酐水平。
结论：在LSG中，动态测量技术，如PVI，SPV,PPV可用于病态肥胖患者，不会引起术中和术后并发症。PVI可能优于其他侵入性方法，因为它是非侵入性的。
