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.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
20
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.
4ml/kg/h of crystal solution was maintained. We excluded patients whose intraoperative bleeding ≥400ml and operative time ≥5 hours from the group.
Guangzhou Red cross hospital
Guangzhou, Guangdong, China
Ees
Ees(End-systole Elasticity,mmHg/ml)
Time frame: Baseline,After induction
Ees
Ees(End-systole Elasticity,mmHg/ml)
Time frame: 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
Time frame: Immediately after the intervention,complete of the second round of the fluid challenge
Ees
Ees(End-systole Elasticity,mmHg/ml)
Time frame: 1h after the first fluid challenge
Ees
Ees(End-systole Elasticity,mmHg/ml)
Time frame: At the end of surgery
SW
SW(Stroke Volume,mmHg·ml)
Time frame: Baseline,after induction
SW
SW(Stroke Volume,mmHg·ml)
Time frame: Immediately after the intervention,complete of the first round of the fluid challenge
SW
SW(Stroke Volume,mmHg·ml)
Time frame: Immediately after the intervention,complete of the second round of the fluid challenge
SW
SW(Stroke Volume,mmHg·ml)
Time frame: 1h after the first fluid challenge
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SW
SW(Stroke Volume,mmHg·ml)
Time frame: At the end of surgery
Ea
Ea(Arterial elasticity, mmHg·ml)
Time frame: Baseline,after induction
Ea
Ea(Arterial elasticity, mmHg·ml)
Time frame: Immediately after the intervention,complete of the first round of the fluid challenge
Ea
Ea(Arterial elasticity, mmHg·ml)
Time frame: Immediately after the intervention,complete of the second round of the fluid challenge
Ea
Ea(Arterial elasticity, mmHg·ml)
Time frame: 1h after the first fluid challenge
Ea
Ea(Arterial elasticity, mmHg·ml)
Time frame: At the end of surgery