PPV和PVI在胃肠肿瘤手术目标导向液体治疗中的疗效对比研究

Comparative study of efficacy of pulse pressure variation(PPV)and pleth variability index(PVI)in goal-directed fluid therapy(GDFT)for gastrointestinal tumor

目的比较脉压变异率(Pulse pressure variation,PPV)与脉搏灌注变异指数(Pleth variability index,PVI)在胃肠肿瘤手术目标导向液体治疗(Goal-directedfluidtherapy,GDFT)中的疗效。方法选取2021年9月-2024年2月在延安市人民医院麻醉科全麻下行腹腔镜胃肠道肿瘤手术的患者106例,采用随机数字表法分为PPV组(n=53)和PVI组(n=53)。两组患者术中背景输液情况为复方氯化钠3 mL·kg^(-1)·h^(-1)。PPV组若PPV≥11%持续1 min,则按照15 mL·kg^(-1)·h^(-1)的速度输注晶体液,若超过15 min则继续胶体液输注,直到PPV<11%持续1 min,恢复背景输液速度。PVI组若PVI≥11%持续1 min,则按照15 mL·kg^(-1)·h^(-1)的速度输注晶体液,若超过15 min则继续胶体液输注,直到PPV<11%持续1 min,恢复背景输液速度。记录患者术中低血压时间加权平均值(Time weighted average of Hypotension,TWAH)、输液情况、尿量;记录患者术毕24 h QoR-15评分、恶心呕吐发生率、肾功能以及肠道排气时间,测定术毕24、48 h患者血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-10的水平。结果与PPV组相比,PVI组术中总输液量、晶体输注量、尿量,术毕24 h和48 h血清IL-6水平更低,差异有统计学意义(P<0.05);两组低血压时间加权平均值、胶体输注量、术毕24 h肾功能、恶心呕吐发生率、肠道排气时间差异均无统计学差异(P>0.05)。结论在腹腔镜胃肠道肿瘤手术中,基于PVI的GDFT并不劣于PPV作为目标的GDFT,该方法无创、简便,值得在临床推广应用。

Objective:Compare the efficacy of pulse pressure variation(PPV)and pleth variability index(PVI)in goal directed fluid therapy(GDFT)for gastrointestinal tumor surgery.Methods:A total of 106 patients who underwent laparoscopic gastrointestinal tumor surgery under general anesthesia in the pital from September 2021 to February 2024 were selected and randomly divided into PPV group(n=53)and PVI group(n=53)using a random number table method.The intraoperativebackground infusion of compound sodium chloride was 3 mL·kg^(-1)·h^(-1).In the PPV group,if PPV≥11%lastedfor 1 minute,the crystal solutionwas injected at a rate of 15 mL·kg^(-1)·h^(-1).If the PPV exceeded 15 min,the colloidal solution was continueduntil the PPV<11%lastedfor 1 min,and the background infusion speed was restored.In the PVI group,if PVI≥11%lastedfor 1 min,the crystal solution wasinjected at the rate of 15 mL·kg^(-1)·h^(-1).If more than 15 min,the colloidal solution was continueduntil the PPV<11%lastedfor 1 min,and the background infusion speed was restored.Time weighted average of Hypotension(TWAH),infusion situation and urine volume were recorded.QoR-15 score,incidence of nausea and vomiting,renal function and intestinal exhaust time were recorded 24 h after surgery.Serum levels of tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6)and IL-10 were measured 24 h and 48 h after surgery.Results:Compared with the PPV group,the PVI group had statistically significant differences in total intraoperative infusion volume,crystal infusion volume,lower urine volume and IL-6 levels both 24 and 48 hours after surgery(P<0.05).There was no statistically significant difference in the weighted average time of hypotension,colloid infusion volume,renal function at 24 hours postoperative,incidence of nausea and vomiting,and intestinal exhaust time between the 2 groups(P>0.05).Conclusion:In laparoscopic gastrointestinal tumor surgery,PVI based GDFT is not inferior to PPV based GDFT.This method is non-invasive,simple,and worthy of clinical promotion and application.