CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 292 AFRICA haemodynamic parameters, can reflect the volume status in the body in real time, lower the incidence rate of postoperative complications and ameliorate the prognosis of patients.9 In our study, the influence of intra-operative fluid management under the guidance of SVV on the short-term prognosis after thoracoscopic lobectomy was explored. Methods This study was approved by the hospital’s ethics committee, and written informed consent was obtained from all patients. A total of 171 patients undergoing thoracoscopic lobectomy for lung cancer in our hospital from April 2017 to April 2019 was selected as the research subjects. All patients received intra-operative fluid management under the guidance of SVV, and they were divided into a low-level group (n = 57, 8% ≤ SVV ≤ 9%), a middle-level group (n = 57, 10% ≤ SVV ≤ 11%) and a high-level group (n = 57, 12% ≤ SVV ≤ 13%) using a random-numbers table. In the low-level group, there were 37 males and 20 females aged 50–75 years, with an average age of 63.42 ± 6.08 years. In the middle-level group, there were 32 males and 25 females aged 51–75 years, with an average of 61.73 ± 5.82 years. In the high-level group, there were 28 males and 29 females aged 52–73 years, with an average age of 62.41 ± 5.73 years. Inclusion criteria were as follows: (1) patients meeting the diagnostic criteria for NSCLC,10 and diagnosed with NSCLC through imaging or pathological examination, (2) those with surgical indications for lobectomy, (3) those in the American Society of Anesthesiologists (ASA) class I–II, (4) those without other respiratory diseases except lung cancer, and (5) those with complete clinical data. Exclusion criteria were as follows: (1) patients complicated with immune system diseases, (2) those with a history of severe infection one week before admission, (3) those complicated with underlying diseases such as hypertension or diabetes, (4) those with mental illness, (5) those accompanied by tumours in other systems or blood diseases, or (6) those with poor compliance. The general data of patients were collected using the electronic medical record, including age, gender, operation time and one-lung ventilation time, fluid infusion amount, amount of bleeding and urine volume during the operation. T1 was defined as the time of stable breathing and haemodynamics during two-lung ventilation after double-lumen tube tracheal intubation. T2 was the time of stable breathing and haemodynamics after two-lung ventilation was replaced with one-lung ventilation, with the patient’s position changed from the horizontal to a lateral position, and T3 was the time of stable breathing and haemodynamics after one-lung ventilation was replaced with two-lung ventilation, with the patient’s position changed from the lateral position to a horizontal position. At T1, T2 and T3, the arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), lung compliance (LC) and peak airway pressure (PAP) were recorded. At T1, T2 and T3, the heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) and stroke volume (SV) were recorded. The usage amount of vasoactive drugs anisodamine (654-2), dopamine, norepinephrine, esmolol and isosorbide dinitrate injection (ABEL) during the operation was recorded. Short-term prognosis indices: the pulmonary function of patients was determined seven days after the operation, including forced expiratory volume in one second (FEV1), percentage of FEV1 in the predicted value (FEV1%pred), forced vital capacity (FVC) and the six-minute walk test (6MWT) distance, based on which FEV1/FVC was calculated. In addition, the postoperative exhaust time, stitch removal time and length of postoperative hospital stay were recorded. Statistical analysis SPSS 19.0 software was used for statistical analysis. Numerical data are expressed as percentage, and intergroup comparison was made by chi-squared test. Measurement data are expressed as mean ± standard deviation, intergroup comparison was conducted by the independent t-test, and intragroup comparison by the paired t-test. Repeated-measures analysis of variance was performed at different time points among the groups, and the independent-samples t-test was adopted at each time point among groups. A p-value < 0.05 was considered statistically significant. Results The fluid infusion amount and urine volume were significantly smaller in the high-level group compared to those in the other two groups (p < 0.05). There were no significant differences in other general data between the three groups (p > 0.05) (Table 1). There were no significant differences in respiratory functions PaO2, PaCO2, LC and PAP at different time points in the three groups (p > 0.05) (Table 2). SV had a significant difference at T2 and T3 in the low-level group (p < 0.05), CVP and SV had significant differences at T2 and T3 in the middle-level group (p < 0.05), and the differences in HR, MAP and CVP were significant at T2 and T3 in the highlevel group (p < 0.05) (Table 3). In the low-level group, the amount of vasoactive drugs dopamine, norepinephrine and esmolol used was significantly less than that in the other two groups, and the amount of ABEL used was also significantly less than that in the high-level group (p < 0.05). No significant difference was found in the amount of 654-2 used in the three groups (p > 0.05) (Table 4). Short-term prognosis indices FEV1, FEV1%pred, FEV1/FVC and 6MWT distance showed no significant differences among the three groups before the operation (p > 0.05), while they Table 1. General data General data Low-level group (n = 57) Middle-level group (n = 57) High-level group (n = 57) Age (years) 63.42 ± 6.08 61.73 ± 5.82 62.41 ± 5.73 Male/female (n) 37/20 32/25 28/29 Operation time (hours) 4.70 ± 0.67 4.83 ± 0.62 4.93 ± 0.58 One-lung ventilation time (hours) 3.52 ± 0.49 3.72 ± 0.53 3.47 ± 0.50 Fluid infusion amount (ml) 2906.73 ± 302.41 2710.31 ± 263.46* 2503.42 ± 245.37*# Amount of bleeding (ml) 146.42 ± 48.31 144.85 ± 46.65 142.78 ± 47.52 Urine volume (ml) 1698.74 ± 285.42 1583.46 ± 264.36* 1425.78 ± 252.64*# *p < 0.05 vs low-level group; #p < 0.05 vs middle-level group.
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