背景:术中液体治疗维持血容量正常,正常组织灌注,正常的代谢功能,正常电解质,和酸碱状态。体积描记变异性指数已被证明可以预测液体反应性,但其在指导术中液体治疗中的作用仍然难以捉摸。
目的:本研究的目的是比较在接受腹部手术的足月新生儿中,基于体积描记变异性指数的术中目标导向液体治疗与自由液体治疗。
方法:在三级护理中心进行了一项前瞻性随机对照研究,为期18个月。在筛查的132名新生儿中,共有30名新生儿完成了这项研究。新生儿气管食管瘘,先天性膈疝,先天性心脏病,呼吸系统疾病,肌酐清除率<90mL/min和血流动力学不稳定者被排除.新生儿被随机分为目标导向的液体治疗组,其中体积描记变异性指数的目标为<18或自由液体治疗组。主要结果是比较两组术中输注的液体总量。次要结果包括术中和术后动脉血气参数,生化参数,使用血管升压药,流体推注的数量,并发症和住院时间。
结果:术中注入的液体总量[90(84-117.5mL)在目标导向液体治疗中与105(85.5-144.5mL)在自由液体治疗组中没有显着差异(p=.406)],中位数差异(95%CI)-15(-49.1至19.1)。从术前到术后24h,两组的血清乳酸水平均下降。与目标定向液体治疗组(36[22-44mL]相比,自由液体治疗组(58[50.25-65mL])在多巴胺给药前输注的液体量明显更高,p=.008),中位数差异(95%CI)-22(-46至2)。在术后期间,两组24小时内的液体摄入总量相当(目标导向液体治疗组222[204-253mL]和自由液体治疗组224[179.5-289.5mL],p=.917)中位数差异(95%CI)截止-2(-65.3至61.2)。
结论:术中体积描记变异性指数指导的目标导向液体治疗在围手术期新生儿注入的液体总量方面与自由液体治疗相当。需要更多具有更高样本量的随机对照试验。
背景:印度中央审判登记处(CTRI/2020/02/023561)。
Intraoperative fluid therapy maintains normovolemia, normal tissue perfusion, normal metabolic function, normal electrolytes, and acid-base status. Plethysmographic variability index has been shown to predict fluid responsiveness but its role in guiding intraoperative fluid therapy is still elusive.
The aim of the present
study was to compare intraoperative goal-directed fluid therapy based on plethysmographic variability index with liberal fluid therapy in term neonates undergoing abdominal surgeries.
A prospective randomized controlled
study was conducted in a tertiary care centre, over a period of 18 months. A total of 30 neonates completed the
study out of 132 neonates screened. Neonates with tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease, respiratory disorders, creatinine clearance <90 mL/min and who were hemodynamically unstable were excluded. Neonates were randomized to goal-directed fluid therapy group where the plethysmographic variability index was targeted at <18 or liberal fluid therapy group. Primary outcome was comparison of total amount of fluid infused intraoperatively in both the groups. Secondary outcomes included intraoperative and postoperative arterial blood gas parameters, biochemical parameters, use of vasopressors, number of fluid boluses, complications and duration of hospital stay.
There was no significant difference in total intraoperative fluid infused [90 (84-117.5 mL) in goal-directed fluid therapy and 105 (85.5-144.5 mL) in liberal fluid therapy group (p = .406)], median difference (95% CI) -15 (-49.1 to 19.1). There was a decrease in serum lactate levels in both groups from preoperative to postoperative 24 h. The amount of fluid infused before dopamine administration was significantly higher in liberal fluid therapy group (58 [50.25-65 mL]) compared to goal-directed fluid therapy group (36 [22-44 mL], p = .008), median difference (95% CI) -22 (-46 to 2). In postoperative period, the total amount of fluid intake over 24 h was comparable in two groups (222 [204-253 mL] in goal-directed fluid therapy group and 224 [179.5-289.5 mL] in liberal fluid therapy group, p = .917) median difference (95% CI) cutoff -2 (-65.3 to 61.2).
Intraoperative plethysmographic variability index-guided goal-directed fluid therapy was comparable to liberal fluid therapy in terms of total volume of fluid infused in neonates during perioperative period. More randomized controlled trials with higher sample size are required.
Central
Trial Registry of India (CTRI/2020/02/023561).