肝脏手术中每搏量变异度与中心静脉压的术中监测：一项基于随机临床试验的Meta分析

肝癌电子杂志 ›› 2023, Vol. 10 ›› Issue (4): 29-37.

肝脏手术中每搏量变异度与中心静脉压的术中监测：一项基于随机临床试验的Meta分析

杜隆德¹, 黄小准², 谢云亮², 周健国³, 毕新宇³, 车旭², 倪勇^4,*

1.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院胸外科,广东深圳 518116;
2.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院肝胆外科,广东深圳 518116;
3.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京 100021;
4.深圳市第二人民医院/深圳大学第一附属医院肝胆胰外科,广东深圳 518035

收稿日期:2023-01-04 出版日期:2023-12-31 发布日期:2024-02-05
通讯作者: ^*倪勇,E-mail:drniyong@163.com
基金资助:
深圳市“医疗卫生三名工程”项目资助（SZSM202011010、SZSM201812079）; 深圳市高水平医院建设专项经费资助（2020）; 中国医学科学院肿瘤医院深圳医院院内科研课题资助（E010322004、SZ2020MS011）

Intraoperative monitoring of stroke volume variation versus central venous pressure in liver surgery: a Meta-analysis of randomized clinical trials

Du Longde¹, Huang Xiaozhun², Xie Yunliang², Zhou Jianguo³, Bi Xinyu³, Che Xu², Ni Yong^4,*

1. Department of Thoracic Surgery, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong,China;
2. Department of Hepatological Surgery, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong, China;
3. Department of Hepatological Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
4. Department of Hepatopancreatobiliary Surgery, Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong, China

Received:2023-01-04 Online:2023-12-31 Published:2024-02-05
Contact: ^*Ni Yong, E-mail: drniyong@163.com

摘要/Abstract

摘要： 目的: 通过Meta分析探究肝切除术中监测的最佳方法。
方法: 从建库至 2022年 12 月 13 日,系统检索PubMed、Web of Science、Embase、CNKI以及Cochrane Library数据库,通过纳入和排除标准筛选出比较每搏量变异度（SVV）导向和低中心静脉压（LCVP）导向的肝切除术中液体管理的随机临床试验,并使用Review Manager 5.3软件对报道的围手术期数据进行统计汇总及分析。
结果: 共纳入10篇随机临床试验,总样本量702例,其中SVV组354例（50.4%）,LCVP组348例（49.6%）。Meta分析结果显示,SVV组的动脉末梢乳酸浓度显著低于LCVP组,两组间的差异有统计学意义（加权均数差=-0.84 mmol/L,95%CI为-1.43~-0.25 mmol/L,P=0.005）。两组术中出血、总并发症发生率差异无统计学意义（均P>0.05）。两组之间的手术世界、术后生化指标、严重并发症发生率和术后急性肾损伤发生率、住院时间的差异均无统计学意义（均P>0.05）。
结论: SVV导向的液体疗法在肝脏手术中的应用是安全的,不会延长手术时间、增加术中出血或手术野质量下降,并且显著降低了接受肝切除术患者的术中乳酸浓度。

关键词: 肝切除术, 每搏量变异度, 低中心静脉压, 目标导向的液体疗法, Meta分析

Abstract: Objective:To explore the best method of monitoring during hepatectomy by Meta-analysis.
Methods:From inception to December 13, 2022, The electronic databases of PubMed, Web of Science, Embase, CNKI and the Cochrane Library were searched. Randomized clinical trials reporting outcomes with comparison between stroke volume variation (SVV) guided goal-directed fluid therapy and low central venous pressure (LCVP) guided fluid therapy during liver surgery were included by inclusion and exclusion criteria. The perioperative data was statistically summarized using Review Manager 5.3 software.
Results:A total of 10 randomized clinical trials were included, with a total sample size of 702 cases, including 354 cases (50.4%) in SVV group and 348 cases (49.6%) in LCVP group. The results of Meta-analysis showed that the arterial lactate concentration in the SVV group was significantly lower than that in the LCVP group, with a statistically significant difference between the two groups (weighted mean difference =-0.84 mmol/L, 95%CI: -1.43 mmol/L to -0.25 mmol/L , P=0.005). The reduce intraoperative bleeding and the incidence of total complications without statistically significant differences(all P>0.05). There were no significant differences in surgical field, postoperative biochemical indexes, incidence of serious complications, incidence of postoperative acute renal injury, and length of hospital stay between the two groups(all P>0.05). Conclusion:The use of SVV directed fluid therapy in liver surgery is safe, does not lead to prolonged operative time, increased intraoperative bleeding, or decreased surgical field quality, and significantly reduces intraoperative lactate concentration in patients undergoing hepatectomy.

Key words: Hepatectomy, Stroke volume variation, Low central venous pressure, Goal-directed fluid therapy, Meta-analysis

杜隆德, 黄小准, 谢云亮, 周健国, 毕新宇, 车旭, 倪勇. 肝脏手术中每搏量变异度与中心静脉压的术中监测：一项基于随机临床试验的Meta分析[J]. 肝癌电子杂志, 2023, 10(4): 29-37.

Du Longde, Huang Xiaozhun, Xie Yunliang, Zhou Jianguo, Bi Xinyu, Che Xu, Ni Yong. Intraoperative monitoring of stroke volume variation versus central venous pressure in liver surgery: a Meta-analysis of randomized clinical trials[J]. Electronic Journal of Liver Tumor, 2023, 10(4): 29-37.

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