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By observing the changes of P-V loop in capacity shock intervention Under Goal-directed Hemodynamic Management in patients undergoing total knee replacement, we investigate the effect of capacity shock on cardiac contractility and work in order to seek a more effective target plan of capacity shock for intraoperative patients.
Objective:By observing the changes of P-V loop in capacity shock intervention Under Goal-directed Hemodynamic Management in patients undergoing total knee replacement, we investigate the effect of capacity shock on cardiac contractility and work in order to seek a more effective target plan of capacity shock for intraoperative patients.
Methods:20 patients with total knee replacement were enrolled in this study. Capacity shock therapy was used in Group A(n=10) and conventional strategy was used in Group B (n=10). V(t) was measured and calculated using TEE and P(t) was acquired by the analysis of patients'radial artery pressure waveform. We set five time points of parameter acquisition: after grouping (T1), the first shock completion(T2), the second shock completion (T3), 1h after shock treatment (T4), and operation completion(T5). We make up the P-V loop fitting P(t) and V(t) at each time point after the calibration of cardiac cycle.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| capacity shock | Experimental | 2ml/kg succinylateol gelatin |
|
| routine management | Other | conventional strategy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fluid challenge strategy | Procedure | Patients received 2ml/kg of succinylateol gelatin within 10 min for fluid shock therapy after grouping, taking SVV as the management target. If SVV< 13% after shock therapy, the shock therapy was stopped and the infusion was maintained with 4ml/kg/h of crystal solution. If SVV ≥ 13% and ΔSV <10%, the individual would be excluded from the experiment. If SVV ≥ 13% but ΔSV≥10%, 2ml/kg of succinylateol gelatin was given again within 10 min for liquid shock therapy until SVV<13%, and 4ml/kg/h of crystal solution was maintained after reaching the target. If SVV≥ 13% after two shock treatments, they were excluded from the experiment. We excluded patients whose intraoperative bleeding ≥400ml and operative time ≥5 hours from the group. |
| Measure | Description | Time Frame |
|---|---|---|
| Ees | Ees（End-systole Elasticity，mmHg/ml） | Baseline，After induction |
| Ees | Ees（End-systole Elasticity，mmHg/ml） | Immediately after the intervention,complete of the first round of the fluid challenge |
| Ees | Arterial elasticity is an invasively determined parameter of arterial load that is inversely related to arterial compliance | Immediately after the intervention,complete of the second round of the fluid challenge |
| Ees | Ees（End-systole Elasticity，mmHg/ml） | 1h after the first fluid challenge |
| Ees | Ees（End-systole Elasticity，mmHg/ml） | At the end of surgery |
| SW | SW（Stroke Volume，mmHg·ml） | Baseline，after induction |
| SW | SW（Stroke Volume，mmHg·ml） | Immediately after the intervention,complete of the first round of the fluid challenge |
| SW | SW（Stroke Volume，mmHg·ml） | Immediately after the intervention,complete of the second round of the fluid challenge |
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Inclusion Criteria:
ASAI-II age 40- 70 weight 48 - 72 kg.
Exclusion Criteria:
Body mass index >30 or <15 kg/m2 Valve heart disease Left ventricular ejection fraction (LVEF) is less than 50% History of lung disease Preoperative arrhythmic disorder Permanent pacemaker Need for mechanical heart Support, Severe extrinsic vascular disease Valve dysfunction OED monitoring probe insertion contraindications Patients with preoperative assessments
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| Name | Affiliation | Role |
|---|---|---|
| Cao Yang | Guangzhou Red Cross Hospital | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Guangzhou Red cross hospital | Guangzhou | Guangdong | 510220 | China |
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|
| conventional strategy | Procedure | 4ml/kg/h of crystal solution was maintained. We excluded patients whose intraoperative bleeding ≥400ml and operative time ≥5 hours from the group. |
|
| SW | SW（Stroke Volume，mmHg·ml） | 1h after the first fluid challenge |
| SW | SW（Stroke Volume，mmHg·ml） | At the end of surgery |
| Ea | Ea(Arterial elasticity, mmHg·ml) | Baseline，after induction |
| Ea | Ea(Arterial elasticity, mmHg·ml) | Immediately after the intervention,complete of the first round of the fluid challenge |
| Ea | Ea(Arterial elasticity, mmHg·ml) | Immediately after the intervention,complete of the second round of the fluid challenge |
| Ea | Ea(Arterial elasticity, mmHg·ml) | 1h after the first fluid challenge |
| Ea | Ea(Arterial elasticity, mmHg·ml) | At the end of surgery |