CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 AFRICA 291 Cardiovascular Topics Effects of intra-operative fluid management under the guidance of stroke volume variability on short-term prognosis after thoracoscopic lobectomy Feng Zhu, Shaolin Cheng, Yang Yang, Xuan Li, Zhen Tang Abstract Aim: We aimed to explore the influence of intra-operative fluid management under the guidance of stroke volume variability (SVV) on the short-term prognosis after thoracoscopic lobectomy. Methods: A total of 171 eligible patients from April 2017 to April 2019 were selected. All patients received intra-operative fluid management under the guidance of SVV, and were divided into low-, middle- and high-level groups (n = 57) using a random-numbers table. The general data, respiratory function indices at different time points, haemodynamic indices at different time points, use of vasoactive drugs, shortterm prognosis indices and incidence of complications were compared. Results: There were no significant differences in age, gender, operation time, one-lung ventilation time, amount of bleeding, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, lung compliance and peak airway pressure at different time points, usage amount of anisodamine and incidence rate of complications among the three groups. In the low-level group, the fluid infusion amount and urine volume were significantly larger, the forced expiratory volume in one second (FEV1), percentage of FEV1 in the predicted value (FEV1%pred) and FEV1/forced vital capacity (FEV1/FVC) seven days after operation were higher, and the six-minute walk test (6MWT) distance was longer than those in the other two groups. The usage amount of dopamine, norepinephrine and esmolol was smaller, and the postoperative exhaust time was shorter than those in the other two groups. The low-level group had a smaller usage amount of isosorbide dinitrate injection and shorter length of postoperative hospital stay than the high-level group. Stroke volume had a significant difference at T2 and T3 in the low-level group, central venous pressure (CVP) and stroke volume had significant differences at T2 and T3 in the middle-level group, and heart rate (HR), mean arterial pressure and CVP were significantly different at T2 and T3 in the high-level group. Conclusion: Fluid management under the guidance of lowlevel SVV (8% ≤ SVV ≤ 9%) was conducive to the maintenance of stable haemodynamics in patients during thoracoscopic lobectomy, thereby improving short-term prognosis. Keywords: stroke volume variability, fluid management, thoracoscopic lobectomy, short-term prognosis, complication Submitted 14/5/21, accepted 9/10/21 Published online 27/10/22 Cardiovasc J Afr 2022; 291–295 www.cvja.co.za DOI: 10.5830/CVJA-2021-049 Lung cancer is a commonmalignant tumour with a high incidence rate, accounting for 13% of all cancers.1 The mortality rate of patients with lung cancer also tops the list among malignancies, seriously threatening the life of patients.2 Histologically, lung cancer is classified into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), the latter of which is dominant, accounting for 85% of the total.3 Therapeutic regimens are different for patients with different subtypes of lung cancer. For example, SCLC patients are mainly treated with chemoradiotherapy, while surgical resection is mainly adopted for early- and mid-stage NSCLC patients, in which lobectomy is an effective treatment means of NSCLC.4 Traditional open lobectomy is associated with great trauma, which may lead to postoperative complications and cause damage to the patient’s body, seriously affecting the prognosis of patients.5 In contrast, thoracoscopic lobectomy is associated with less trauma, milder postoperative pain, faster recovery and fewer postoperative complications.6 With a good visual field during the operation, thoracoscopic lobectomy can completely remove the lesions and reduce unnecessary damage to the blood vessels and lung tissues.7 As a commonly used non-physiological ventilation strategy in thoracic surgery, one-lung ventilation can reduce intraoperative mechanical damage and postoperative infection, but it may result in volume overload and pulmonary oedema.8 Intra-operative fluid management under the guidance of stroke volume variability (SVV), through dynamically monitoring Department of Cardiothoracic Surgery, Bengbu First People’s Hospital, Bengbu, China Feng Zhu, MD Shaolin Cheng, MD Yang Yang, MD Xuan Li, MD Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China Zhen Tang, MD, atnitinodebt@web.de, yifangang935@163.com
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