Abstract：Objective This study aimed to evaluate the application value of pleth variability index (PVI) in the peri-operative liquid control of patients undergoing laparoscopic gastrointestinal surgery.Methods This prospective study was conducted from September 2019 to September 2020. Sixty patients (39 males and 21 females, aged 60-70 years old, Grade Ⅱ-Ⅲ of American Society of Anesthesiologists) were enrolled in the First Affiliated Hospital of Bengbu Medical College for laparoscopic gastrointestinal surgery. Random-number table method was used to divide the patients into two groups. The observation group (30 cases) received fluid rehydration under the guidance of PVI, while the control group (30 cases) received fluid supplementation under the guidance of central venous pressure and mean arterial pressure. Patient PVI, perfusion index (PI), and patient status index (PSI) were continuously monitored using Masimo Radical-7 and SedLine, and PSI was maintained between 25 and 50 intra-operatively. The outcome measures were as follows: (1) The baseline data of the two groups were compared. (2) Peri-operative observation indicators, including intraoperative crystal input, colloidal input, total infusion volume, urine volume, extubation time, post-anesthesia care unit(PACU) time, observer's assessment of alertness/sedation (OAA/S) score, exhaust time, and length of hospital stay were observed ;(3) Hemodynamics and volume indexes, including heart rate, mean arterial pressure, PVI, PI, and central venous pressure of patients were observed at 6 min after admission (T0), 6 min after intubation (T1), skin incision (T2), gastrointestinal anastomosis (T3), and 6 min after extubation (T4). (4) Inflammatory cytokines and arterial blood lactic acid indices, including C-reactive protein, endotoxin, procalcitonin, and lactic acid in plasma were observed before and at 1 and 3 days after surgery.Results (1) No significant difference was observed in the baseline data between the two groups (all P values＞0.05). (2) No statistically significant differences were observed in extubation time, PACU time, OAA/S score, and length of hospital stay between the two groups (all P values＞0.05). The crystal fluid volume, total infusion volume, urine volume, and exhaust time in the control group were significantly higher than those in the observation group, while the colloidal fluid volume was significantly lower than that in the observation group (all P values＜0.05). (3) No significant differences were observed in the heart rate, mean arterial pressure, and perfusion index between the two groups at different time (all P values＞0.05). The variation index of central venous pressure and pulse perfusion in the control group were higher than those in the observation group, the differences of the former at T2 and T4 and that of the latter at T1 and T4 were statistically significant (all P values＜0.05). Based on the comparison at different time points with each groups, no significant difference was observed in the perfusion index and heart rate of the control group and the average arterial pressure of the observation group (all P values＞0.05). Compared with T0 at each time point, the heart rate of observation group at T1-T3 gradually decreased but increased at T4. In the control group, the mean arterial pressure decreased at T1 and increased gradually at T2-T4. The central venous pressure in two groups decreased at T1 and gradually increased at T2-T4. The PVI at T1-T4 of two groups decreased gradually(all P values＜0.05). (4) The endotoxin, C-reactive protein, and lactic acid in two groups were higher than those before surgery 1 and 3 days after surgery, and the values from the control group were significantly higher than those from the observation group; the differences were statistically significant (all P values＜0.05).Conclusions The application of PVI monitoring in laparoscopic gastrointestinal surgery can effectively guide fluid management, maintain appropriate circulation capacity and balance of tissue oxygen supply and demand, inhibit the inflammatory response of the body, and play a positive role in the rapid recovery of the body.
孙宜云, 凌云志, 杨栋栋, 李芷依, 黄静文, 董成成. 脉搏灌注变异指数在腹腔镜胃肠手术患者围术期液体管理中的应用价值[J]. 中华解剖与临床杂志, 2021, 26(3): 339-345.
Sun Yiyun, Ling Yunzhi, Yang Dongdong, Li Zhiyi, Huang Jingwen, Dong Chengcheng. Application value of pleth variability index in the peri-operative liquid control of patients undergoing laparoscopic gastrointestinal surgery. Chinese Journal of Anatomy and Clinics, 2021, 26(3): 339-345.
Resalt-Pereira M, Muñoz JL, Miranda E, et al. Goal-directed fluid therapy on laparoscopic colorectal surgery within enhanced recovery after surgery program[J]. Rev Esp Anestesiol Reanim, 2019, 66(5): 259-266. DOI:10.1016/j.redar.2019.01.007.
[2]
Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess[J]. Br J Anaesth, 2002, 89(4): 622-632. DOI:10.1093/bja/aef220.
[3]
Yuan J, Sun Y, Pan C, et al. Goal-directed fluid therapy for reducing risk of surgical site infections following abdominal surgery-a systematic review and meta-analysis of randomized controlled trials[J]. Int J Surg, 2017, 39: 74-87. DOI:10.1016/j.ijsu.2017.01.081.
[4]
Michard F, Giglio MT, Brienza N. Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome[J]. Br J Anaesth. 2017, 119(1): 22-30. DOI:10.1093/bja/aex138.
[5]
Rollins KE, Lobo DN. Intraoperative goal-directed fluid therapy in elective major abdominal surgery: a meta-analysis of randomized controlled trials[J]. Ann Surg, 2016, 263(3): 465-476. DOI:10.1097/SLA.0000000000001366.
[6]
Arrick L, Mayson K, Hong T, et al. Enhanced recovery after surgery in colorectal surgery: impact of protocol adherence on patient outcomes[J]. J Clin Anesth, 2019, 55: 7-12. DOI:10.1016/j.jclinane.2018.12.034.
Yu SS, Zhao XC. Strategies and progress of perioperative goal-directed fluid therapy[J]. Medical Recapitulate, 2018, 24(21): 4286-4291. DOI:10.3969/j.issn.1006-2084.2018.21.025.
[8]
Kim DH, Shin S, Kim JY, et al. Pulse pressure variation and pleth variability index as predictors of fluid responsiveness in patients undergoing spinal surgery in the prone position[J]. Ther Clin Risk Manag, 2018, 14: 1175-1183. DOI:10.2147/TCRM.S170395.
[9]
Liu F, Zhu S, Ji Q, et al. The impact of intra-abdominal pressure on the stroke volume variation and plethysmographic variability index in patients undergoing laparoscopic cholecystectomy[J]. Biosci Trends, 2015, 9(2): 129-133. DOI:10.5582/bst.2015.01029.
[10]
Cesur S, çardaközü T, Kuş A, et al. Comparison of conventional fluid management with PVI-based goal-directed fluid management in elective colorectal surgery[J]. J Clin Monit Comput, 2019, 33(2): 249-257. DOI:10.1007/s10877-018-0163-y.
[11]
Cannesson M, Desebbe O, Rosamel P, et al. Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre[J]. Br J Anaesth, 2008, 101(2): 200-206. DOI:10.1093/bja/aen133.
Yin JY, Li YS, Li JS. The basic principle and clinical application of pulse oxygen volume variation index in predicting dilatation response[J]. Chin Crit Care Med, 2013, 25(5): 314-318. DOI:0.37601cma.J.issn.2095-4352.2013.05.020.
[13]
Coeckelenbergh S, Delaporte A, Ghoundiwal D, et al. Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial[J]. BMC Anesthesiol. 2019, 19(1): 34. DOI:10.1186/s12871-019-0707-9.
[14]
Demirel İ, Bolat E, Altun AY, et al. Efficacy of goal-directed fluid therapy via pleth variability index during laparoscopic Roux-en-Y gastric bypass surgery in morbidly obese patients[J]. Obes Surg, 2018, 28(2): 358-363. DOI:10.1007/s11695-017-2840-1.
[15]
Forget P, Lois F, de Kock M. Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management[J]. Anesth Analg, 2010, 111(4): 910-914. DOI:10.1213/ANE.0b013e3181eb624f.
[16]
Kröll D, Nakhostin D, Stirnimann G, et al. C-reactive protein on postoperative day 1: a predictor of early intra-abdominal infections after bariatric surgery[J]. Obes Surg, 2018, 28(9): 2760-2766. DOI:10.1007/s11695-018-3240-x.
[17]
Benoit O, Faron M, Margot N, et al. C-reactive protein values after colorectal resection: can we discharge a patient with a C-reactive protein value >100? A retrospective cohort study[J]. Dis Colon Rectum, 2019, 62(1): 88-96. DOI:10.1097/DCR.0000000000001216.
[18]
Valenza F, Aletti G, Fossali T, et al. Lactate as a marker of energy failure in critically ill patients: hypothesis[J]. Crit Care, 2005, 9(6): 588-593. DOI:10.1186/cc3818.
[19]
Ikeda T, Ikeda K, Suda S, et al. Usefulness of the endotoxin activity assay as a biomarker to assess the severity of endotoxemia in critically ill patients[J]. Innate Immun, 2014, 20(8): 881-887. DOI:10.1177/1753425913516885.
Wang H, Ye H, Liu Y, et al. Study of procalcitonin in evaluating the condition and prognosis of patients with pelvic abscess[J]. Chinese Journal for Clinicians. 2019, 47(8): 972-975. DOI:10.3969/j.issn.2095-8552.2019.08.031
Long T, Bai RR, Li Z, et al. Influence of procalcitonin and C-reactive protein on prognosis of patients with postoperative severe sepsis[J]. Chin J Nosocomiol, 2015, 25(13): 2881-2883. DOI:10.11816/cn.ni.2015-141147.
[22]
Cavallaro F, Sandroni C, Antonelli M. Functional hemodynamic monitoring and dynamic indices of fluid responsiveness[J]. Minerva Anestesiol, 2008, 74(4): 123-35.
2021, Vol. 26 
