Background: 

Fluid imbalance is common after aneurysmal subarachnoid hemorrhage and negatively impacts clinical outcomes. We compared intraoperative goal-directed fluid therapy (GDFT) using left ventricular outflow tract velocity time integral (LVOT-VTI) measured by transesophageal echocardiography with central venous pressure (CVP)-guided fluid therapy during aneurysm clipping in aneurysmal subarachnoid hemorrhage patients.

Methods: 

Fifty adults scheduled for urgent craniotomy for aneurysm clipping were randomly allocated to 2 groups: group G (n=25) received GDFT guided by LVOT-VTI and group C (n=25) received CVP-guided fluid management. The primary outcome was intraoperative mean arterial pressure (MAP). Secondary outcomes included volume of fluid administered and several other intraoperative and postoperative variables, including neurological outcome at hospital discharge and at 30 and 90 days.

Results: 

There was no difference in MAP between the 2 groups despite patients in group G receiving lower volumes of fluid compared with patients in group C (2503.6±534.3 vs. 3732.8±676.5 mL, respectively; P<0.0001). Heart rate and diastolic blood pressure were also comparable between groups, whereas systolic blood pressure was higher in group G than in group C at several intraoperative time points. Other intraoperative variables, including blood loss, urine output, and lactate levels were not different between the 2 groups. Postoperative variables, including creatinine, duration of postoperative mechanical ventilation, length of intensive care unit and hospital stay, and incidence of acute kidney injury, pneumonitis, and vasospasm were also comparable between groups. There was no difference in neurological outcome at hospital discharge (modified Rankin scale) and at 30 and 90 days (Extended Glasgow Outcome Scale) between the 2 groups.

Conclusion: 

Compared with CVP-guided fluid therapy, transesophageal echocardiography–guided GDFT maintains MAP with lower volumes of intravenous fluid in patients undergoing clipping of intracranial aneurysms with no adverse impact on postoperative complications.

中文翻译：

---

开颅和夹闭脑动脉瘤期间目标导向液体治疗与常规液体治疗：一项前瞻性随机对照试验

背景： 

动脉瘤性蛛网膜下腔出血后体液失衡很常见，并对临床结果产生负面影响。我们比较了使用经食道超声心动图测量的左心室流出道速度时间积分 (LVOT-VTI) 的术中目标导向液体治疗 (GDFT) 与动脉瘤性蛛网膜下腔出血患者动脉瘤夹闭期间中心静脉压 (CVP) 引导的液体治疗。

方法： 

50 名因动脉瘤夹闭而进行紧急开颅手术的成人被随机分配到 2 组：G 组（n=25）接受 LVOT-VTI 引导的 GDFT，C 组（n=25）接受 CVP 引导的液体管理。主要结果是术中平均动脉压（MAP）。次要结果包括输液量和其他几个术中和术后变量，包括出院时以及 30 天和 90 天时的神经系统结果。

结果： 

尽管与 C 组患者相比，G 组患者接受的液体量较少，但两组之间的 MAP 没有差异（分别为 2503.6±534.3 对 3732.8±676.5 mL；P<0.0001)。各组之间的心率和舒张压也具有可比性，而 G 组的收缩压在几个术中时间点高于 C 组。其他术中变量，包括失血量、尿量和乳酸水平在两组之间没有差异。术后变量，包括肌酐、术后机械通气时间、重症监护病房时间和住院时间，以及急性肾损伤、肺炎和血管痉挛的发生率在各组之间也具有可比性。两组在出院时（改良 Rankin 量表）和 30 天和 90 天（扩展格拉斯哥结果量表）的神经系统结果没有差异。

结论： 

与 CVP 引导的液体治疗相比，经食道超声心动图引导的 GDFT 可在颅内动脉瘤夹闭患者中维持 MAP 并减少静脉输液量，且对术后并发症无不良影响。