Cardiovascular Journal of Africa: Vol 33 No 6 (NOVEMBER/DECEMBER 2022)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 294 AFRICA recovery and fewer postoperative complications, greatly reducing the damage to the body of patients.14 One-lung ventilation, as a non-physiological ventilation strategy, is usually required during lobectomy. This method isolates the two lungs, reduces the incidence rate of postoperative infection, and alleviates mechanical damage and lung injury during operation.15 However, one-lung ventilation can easily lead to rapid fluctuations in haemodynamics, leading to hypoxia– reperfusion injury in patients, inducing lung inflammation, acute respiratory distress syndrome and acute lung injury, with a mortality rate of 25–60%, seriously affecting surgical effect and the prognosis of patients.16 Moreover, the volume overload caused by one-lung ventilation will also affect the organ’s functional recovery, causing postoperative complications.17 Reasonable fluid management can offer satisfactory tissue perfusion and oxygen supply and keep the haemodynamics stable in patients during lobectomy. SVV, a new guidance for fluid management, can be used to accurately predict the volume status of patients during operation, so that the cardiac preload is optimised, the effective circulating blood volume is maintained, and arterial oxygenation is improved, thus reducing the incidence of postoperative complications and ameliorating the prognosis.18 However, fluid management under the guidance of different levels of SVV has varying effects on the intra-operative and postoperative indices, surgical effect and postoperative complications in patients undergoing thoracoscopic lobectomy. Therefore, it is particularly important to optimise the SVV level for guiding the fluid management during lobectomy, enhancing the treatment effect on patients, and improving the prognosis of patients. Respiratory failure is a common complication in patients with lung cancer during and after lobectomy, which can cause death in severe cases, do great harm to the health of patients, and affect the surgical efficacy.19 Therefore, respiratory function indices PaO2, PaCO2, LC and PAP should be monitored in real time during lobectomy for lung cancer patients. As for the important indices for haemodynamic changes, HR, MAP, CVP and SV, Benes et al.20 compared the influence of goal-orientated fluid therapy under the guidance of SVV and traditional fluid therapy on the haemodynamic parameters of elderly patients undergoing radical surgery of lung cancer at different time points. They found that the cardiac index, MAP and CVP had the most obvious changes in the traditional fluid therapy group at different time points, while goal-orientated fluid therapy under the guidance of SVV could stabilise the peri-operative haemodynamics in patients. In our study, the haemodynamics was relatively stable in the low-level group, consistent with the literature report. Lung damage is usually found in lung cancer patients after lobectomy. FEV1, FEV1%pred, FVC, FEV1/FVC and 6MWT are all important indices for assessing the lung function, and they can also be used to evaluate the postoperative short-term prognosis of patients. In addition, postoperative exhaust time, stitch removal time and postoperative length of hospital stay are also key indices used to assess the postoperative short-term prognosis of patients. In the present study, in the low-level group, postoperative FEV1, FEV1%pred and FEV1/FVC were significantly higher, and 6MWT distance was significantly longer than those in the other two groups, while the postoperative exhaust time was significantly shorter than that in the other two groups. Besides, the low-level group had significantly shorter length of postoperative hospital stay than the high-level group. Complications such as pulmonary oedema, pulmonary infection, hypertension, arrhythmia and pulmonary embolism often occur in lung cancer patients after lobectomy. According to a study, fluid management under the guidance of SVV is able to markedly reduce the incidence of complications after thoracoscopic lobectomy.21 In this study, the incidence rate of postoperative complications was not significantly different among the three groups. This study has limitations. It was a single-centre study with a small sample size. The findings herein will be further validated by our group by performing multi-centre studies with larger sample sizes. Conclusion Fluid management under the guidance of low-level SVV (8% ≤ SVV ≤ 9%) was conducive to the maintenance of stable haemodynamics in patients during thoracoscopic lobectomy, thereby improving the short-term prognosis of patients. References 1. Shen J, Wang B, Zhang T, et al. 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Zhang R, Kyriss T, Dippon J, et al. Impact of comorbidity burden on morbidity following thoracoscopic lobectomy: A propensity-matched analysis. J Thorac Dis 2018; 10(3): 1806–1814. 7. Richardson MT, Backhus LM, Berry MF, et al. Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes. J Thorac Cardiovasc Surg 2018; 155(3): 1267–1277. 8. Sheybani S, Sharifian Attar A, Golshan S, et al. Effect of propofol and isoflurane on gas exchange parameters following one-lung ventilation in thoracic surgery: a double-blinded randomized controlled clinical trial. Electron Physician 2018; 10(2): 6346–6353. 9. Al-Ghamdi AA. Intraoperative fluid management: Past and future, where is the evidence? Saudi J Anaesth 2018; 12(2): 311–317. 10. Funkhouser Jr WK, Hayes DN, Moore DT, et al. Interpathologist diagnostic agreement for Non–Small cell lung carcinomas using current and recent classifications. Arch Pathol Lab Med 2018; 142(12): 1537–1548. 11. Yao D, Gu P, Wang Y, et al. Inhibiting polo-like kinase 1 enhances radiosensitization via modulating DNA repair proteins in non-small-cell

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