Clinical study of pulse variability index in guiding laparoscopic intestinal tumor surgery
LUO Rui ZHU Yan-hong▲ LIAO Fei
Department of Anesthesiology, People′s Hospital of Yuxi City, the Sixth Affiliated Hospital of Kunming Medical University, Yunnan Province, Yuxi 653100, China
Abstract：Objective To explore the clinical application value of goal-directed fluid therapy under the guidance of pulse variability index (PVI) in laparoscopic intestinal tumor surgery.Methods Forty patients who underwent elective laparoscopic intestinal tumor surgery in our hospital from January 2018 to July 2019 were selected as the research subjects, and they were divided into group S and group D according to the random number table method, 20 cases in each group.Patients in group S were guided by PVI for intraoperative fluid therapy, and patients in group D were judged comprehensively for intraoperative fluid therapy based on indicators such as heart rate (HR), blood pressure, and central venous pressure (CVP).The hemodynamic indicators (mean arterial pressure [MAP], HR, CVP, PVI, pulse perfusion index[PI])at the following time points were recorded in the two groups of patients,like room admission(T1),after anesthesia intubation (T2), 5 minutes after the pneumoperitoneum was established (T3), when the tumor was removed (T4),5 minutes after the deflation of the abdomen (T5), and the completion of the surgery (T6).The surgery time, total infusion volume, urine volume, blood loss and intraoperative anesthetic drug use of the two groups were recorded, and the postoperative exhaust time, the incidence of lung and gastrointestinal adverse events in the two groups were observed.Results There were no significant differences in MAP, HR, CVP, PVI, and PI at T1-T3 and T5-T6 between the two groups (P＞0.05).At T4, the HR of group S ([64.00±6.62]times/min) was lower than that of group D ([73.89±8.08]times/min), and the difference was statistically significant (P＜0.05).There were no statistically significant differences in surgery time, urine volume, blood loss and intraoperative anesthetic drug use between the two groups (P ＞0.05).The total infusion volume of patients in group S([2502.53±347.62]ml) was less than that in group D ([2778.60±366.62]ml), and the difference was statistically significant (P＜0.05).The postoperative exhaust time of group S ([56.52±29.66]h) was shorter than that of group D ([82.67±40.71]h), and the difference was statistically significant (P＜0.05).There was no statistically significant difference in the incidence rate of lung adverse events between the two groups (P＞0.05).The incidence rate of gastrointestinal adverse events in group S (5.0%) was lower than that in group D (30.0%), and the difference was statistically significant (P＜0.05).Conclusion PVI used to guide the liquid therapy in laparoscopic intestinal tumor surgery can reduce the fluid input while maintaining the stability of the circulation, and it is beneficial to the rapid recovery of patients after surgery and can reduce the incidence of gastrointestinal adverse events, which is worthy of clinical recommendation.
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