Effect of goal-directed fluid therapy on brain tumor resection: A systematic review and meta-analysis

doi:10.3969/j.issn.1004-583X.2023.08.002

Abstract

Abstract:

Objective To systematically evaluate the effect of goal-directed fluid therapy (GDFT) on brain tumor resection. Methods Relevant articles reporting the application of GDFT to brain tumor resection published from the inception to April 2022 were searched in online databases, including the PubMed, Embase, Cochrane Library, Web of Science, VIP database, CNKI, WanFang database, and Chinese Biomedical Database (CBM). Eligible studies were screened according to the inclusion and exclusion criteria. After quality evaluation and extraction of relevant data, RevMan5.3 software and Stata SE16.0 software were used for meta-analysis. Results A total of 17 eligible randomized controlled trials (RCTs) involving 962 patients were included. Meta-analysis results showed that at the end of surgery, patients in GDFT group had increased cardiac index (CI) (MD=0.45; 95%CI: 0.36, 0.55; P<0.01), mean arterial pressure (MAP) (MD=6.14; 95%CI: 4.85, 7.44; P<0.01), and jugular bulb mixed oxygen saturation (SjvO₂) (1 hour after incision of the dura: MD=4.77; 95%CI: 2.58, 6.96; P<0.01; at the end of surgery: MD=4.42; 95%CI: 1.21, 7.62; P=0.007), but significantly lower blood lactate (Lac) (MD=-0.57; 95%CI: -0.77, -0.37; P<0.01) than those of regular fluid group. The postoperative National Institute of Health stroke (NIHSS) score decreased [24 h after surgery: MD=-2.95; 95%CI: -3.85, -2.05; P<0.01), and the postoperative Mini-mental State Examination (MMSE) score increased (1 day after surgery: MD= 1.12; 95%CI: 0.26, 1.99; P=0.01; 3 days after surgery: MD=1.40; 95%CI: 0.75, 2.05; P<0.01) in patients of GDFT group than those of regular fluid group. Conclusion GDFT can maintain hemodynamic stability, improve tissue perfusion, sustain oxygen supply-demand balance, and facilitate postoperative recovery in patients undergoing brain tumor resection.

Key words: goal-directed fluid therapy, brain tumor resection, meta-analysis

CLC Number:

R739.41

Hou Youling, Li Yi, Guan Hongyu, Luo Hongxia. Effect of goal-directed fluid therapy on brain tumor resection: A systematic review and meta-analysis[J]. Clinical Focus, 2023, 38(8): 686-693.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.08.002

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I8/686

Figures/Tables 13

References 40

[1]	韩仁强, 周金意, 张思维, 等. 2015年中国脑瘤发病与死亡分析[J]. 中国肿瘤, 2021, 30(1):29-34.
[2]	Gruenbaum SE, Meng L, Bilotta F. Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection[J]. Curr Opin Anaesthesiol, 2016, 29(5): 552-557. doi: 10.1097/ACO.0000000000000365 pmid: 27285727
[3]	Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens: A randomized assessor-blinded multicenter trial[J]. Ann Surg, 2003, 238(5): 641-648. doi: 10.1097/01.sla.0000094387.50865.23 pmid: 14578723
[4]	Wrzosek A, Jakowicka-Wordliczek J, Zajaczkowska R, et al. Perioperative restrictive versus goal‐directed fluid therapy for adults undergoing major non‐cardiac surgery[J]. Cochrane Database Syst Rev, 2019, 12(12):CD012767.
[5]	Ryu T. Fluid management in patients undergoing neurosurgery[J]. Anesth Pain Med (Seoul), 2021, 16(3): 215-224.
[6]	何小义, 邹学军, 刑浩然. 目标导向液体治疗用于加速康复外科的新进展[J]. 基础医学与临床, 2020, 40(7):995-998.
[7]	王骜, 章放香, 彭晶, 等. 围手术期目标导向液体治疗的研究进展[J]. 医学综述, 2021, 27(20):4058-4062.
[8]	Mayer J, Boldt J, Mengistu A M, et al. Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: A randomized, controlled trial[J]. Critical Care, 2010, 14(1): 1-9.
[9]	Benes J, Chytra I, Altmann P, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: Results of prospective randomized study[J]. Critical Care, 2010, 14(3): 1-15.
[10]	Rhodes A, Cecconi M, Hamilton M, et al. Goal-directed therapy in high-risk surgical patients: A 15-year follow-up study[J]. Intensive Care Med, 2010, 36(8): 1327-1332. doi: 10.1007/s00134-010-1869-6 pmid: 20376431
[11]	Dalfino L, Giglio MT, Puntillo F, et al. Haemodynamic goal-directed therapy and postoperative infections: Earlier is better. A systematic review and meta-analysis[J]. Critical Care, 2011, 15(3): 1-14.
[12]	Hasanin A, Zanata T, Osman S, et al. Pulse pressure variation-guided fluid therapy during supratentorial brain tumour excision: A randomized controlled trial[J]. Open Access Maced J Med Sci, 2019, 7(15): 2474-2479. doi: 10.3889/oamjms.2019.682 pmid: 31666850
[13]	Mishra N, Rath G P, Bithal P K, et al. Effect of goal-directed intraoperative fluid therapy on duration of hospital stay and postoperative complications in patients undergoing excision of large supratentorial tumors[J]. Neurol India, 2022, 70(1): 108-114. doi: 10.4103/0028-3886.336329 pmid: 35263862
[14]	伍淑韫, 刘湘杰, 王涛. 脉压变异度指导的目标导向液体治疗在幕上肿瘤切除术中的应用[J]. 云南医药, 2020, 41(2):162-164.
[15]	吴洁, 马艳辉, 张瑛, 等. 每搏变异度指导目标导向液体管理在幕上肿瘤切除术中的应用[J]. 临床麻醉学杂志, 2017, 33(5):425-429.
[16]	张杰, 施庆余, 罗爱林. 麻醉期间目标导向液体治疗对胶质瘤开颅切除术患者预后的影响[J]. 华中科技大学学报(医学版), 2012, 41(1):99-102.
[17]	易勇, 周章明, 梁张. 目标导向液体治疗对脑膜瘤切除术患者脑代谢和手术后康复的影响[J]. 中国肿瘤临床与康复, 2016, 23(8):925-928.
[18]	潘晓燕. 胸腔内血容量指数指导的GDFT对脑肿瘤切除术患者术后认知影响[J]. 现代仪器与医疗, 2017, 23(5):123-124.
[19]	王学飞. 目标导向液体对择期神经外科手术患者术中颅内压及脑氧供需平衡的影响[J]. 河南医学研究, 2016, 25(11):1988-1989.
[20]	王德勇, 石祥飞. 目标导向液体治疗对脑肿瘤切除术后氧代谢的影响[J]. 中国继续医学教育, 2019, 11(28):112-114.
[21]	王慧霞, 廉欢. 术中目标导向液体对脑肿瘤切除术后患者血液动力学指标及血清中S-100β浓度的影响[J]. 中国疗养医学, 2021, 30(4):406-408. doi: 10.13517/j.cnki.ccm.2021.04.026
[22]	田胜兰, 周游, 冯丹. 目标导向液体治疗在择期神经外科手术中对颅内压和脑氧供需平衡的影响[J]. 华中科技大学学报(医学版), 2015, 44(1):106-109.
[23]	莫朴, 陈海林, 利鸿胜. 麻醉期间目标导向液体治疗对胶质瘤开颅切除术患者预后的影响[J]. 中国当代医药, 2015, 22(35):112-114+117.
[24]	袁柳青, 李凤仙, 徐世元, 等. 目标导向液体治疗对脑膜瘤切除术患者心指数及术后康复的影响[J]. 实用医学杂志, 2013, 29(9):1458-1460.
[25]	袁柳青, 李凤仙, 刘世乐, 等. 目标导向液体治疗对脑膜瘤切除术患者脑氧代谢的影响[J]. 临床麻醉学杂志, 2013, 29(4):317-321.
[26]	袁柳青, 梁伟东, 李晓玲, 等. Vigileo监测SVV指导目标导向液体治疗在脑膜瘤切除术中的应用[J]. 赣南医学院学报, 2020, 40(4):392-395.
[27]	袁柳青, 梁伟东, 李晓玲, 等. 基于每博量变异的目标导向液体治疗对脑膜瘤切除术血流动力学和S100β蛋白的影响[J]. 实用医学杂志, 2020, 36(22):3126-3129.
[28]	赵晓生, 王群涛, 赵芳芳, 等. 目标导向液体治疗脑肿瘤及对患者围术期认知功能的影响研究[J]. 中国全科医学, 2019, 22(S1):48-50.
[29]	伊敏敏, 郭永清. 神经外科颅脑肿瘤手术围手术期脑保护的研究进展[J]. 医学综述, 2020, 26(17):3491-3495.
[30]	梁禹. 神经外科麻醉进展[J]. 医学综述, 2008, 14(24):3805-3808.
[31]	Berger K, Francony G, Bouzat P, et al. Prone position affects stroke volume variation performance in predicting fluid responsiveness in neurosurgical patients[J]. Minerva Anestesiol, 2015, 81(6): 628-635. pmid: 25263024
[32]	van der Jagt M. Fluid management of the neurological patient: A concise review[J]. Critical Care, 2016, 20(1): 1-11. doi: 10.1186/s13054-015-1178-0 URL
[33]	Orfanakis A, Brambrink AM. Long-term outcome call into question the benefit of positive fluid balance and colloid treatment after aneurysmal subarachnoid hemorrhage[J]. Neurocrit Care, 2013, 19(2):137-139. pmid: 24022830
[34]	Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis[J]. Crit Care, 2015, 19(1):251. doi: 10.1186/s13054-015-0970-1 URL
[35]	Mascia L, Sakr Y, Pasero D, et al. Extracranial complications in patients with acute brain injury: A post-hoc analysis of the SOAP study[J]. Intensive Care Med, 2008, 34(4):720-727. doi: 10.1007/s00134-007-0974-7 URL
[36]	Kirov MY, Kuzkov VV, Molnar Z. Perioperative haemodynamic therapy[J]. Curr Opin Crit Care, 2010, 16(4): 384-392. doi: 10.1097/MCC.0b013e32833ab81e pmid: 20508520
[37]	Luo J, Xue J, Liu J, et al. Goal-directed fluid restriction during brain surgery: A prospective randomized controlled trial[J]. Ann Intensive Care, 2017, 7(1): 16. doi: 10.1186/s13613-017-0239-8 pmid: 28211020
[38]	Zhang N, Liang M, Zhang DD, et al. Effect of goal-directed fluid therapy on early cognitive function in elderly patients with spinal stenosis: A Case-Control Study[J]. Int J Surg, 2018, 54(Pt A): 201-205. doi: S1743-9191(18)30687-3 pmid: 29678619
[39]	Tang A, Zhou S. Analysis on the application value of goal-directed fluid therapy in patients undergoing laparoscopy-assisted radical gastrectomy with fast-track anesthesia[J]. Am J Transl Res, 2021, 13(5):5174-5182. pmid: 34150106
[40]	Crum RM, Anthony JC, Bassett SS, et al. Population-based norms for the Mini-Mental State Examination by age and educational level[J]. JAMA, 1993, 269(18): 2386-2391. doi: 10.1001/jama.1993.03500180078038 URL

纳入研究	年龄(岁)		样本量(例)		监测指标	结局指标
纳入研究	目标导向液体组	常规液体组	目标导向液体组	常规液体组	监测指标	结局指标
Hasanin 2019^[12]	41±12	39±13	31	30	PPV>13	⑤
Mishra 2022^[13]	44±12.6	39±11	20	20	SVV>12	①②⑤
伍淑韫 2020^[14]	18~65		30	30	PPV>13	②⑤
吴洁 2017^[15]	50±9	50±9	33	30	SVV>12	⑤
张杰 2012^[16]	42±12	42±10	20	20	SVV>13	①②⑤
易勇 2016^[17]	53±4.8	52.5±4.9	53	53	SVV>13	②④⑤⑥
潘晓燕 2017^[18]			58	57	ITBVI:800~1000 ml/m²	③④⑦⑧
王学飞 2016^[19]	39.6±3.6	40.1±4.2	27	25	SVV>12	①②③④
王德勇 2019^[20]	60.13±12.31	60.21±12.24	25	25	ITBVI:800~1000 ml/m²	⑤⑥
王慧霞 2021^[21]	40.96±2.29	41.87±2.42	48	47	SVV>13	②⑧
田胜兰 2015^[22]	54.7±4.2	52.5±6.3	12	12	SVV>12	①②③④
莫朴 2015^[23]	43.2±9.7		40	40	ITBVI:800~1000 ml/m²	②⑥
袁柳青 2013(心指数)^[24]	18~60		14	12	ITBVI:800~1000 ml/m²	①⑥
袁柳青 2013(脑氧代谢)^[25]	47.3±11.1	49.8±10.3	14	12	ITBVI:800~1000 ml/m²	③④⑤
袁柳青 2020(vigileo 监测)^[26]	47.1±11.2	45.3±12.4	20	20	SVV>13	⑦⑧
袁柳青 2020(基于每博变异)^[27]	46.4±8.2	45.7±8.1	23	23	SVV>13	①②⑦⑧
赵晓生 2019^[28]			19	19	SVV>13	⑦⑧

纳入研究	年龄(岁)		样本量(例)		监测指标	结局指标
纳入研究	目标导向液体组	常规液体组	目标导向液体组	常规液体组	监测指标	结局指标
Hasanin 2019^[12]	41±12	39±13	31	30	PPV>13	⑤
Mishra 2022^[13]	44±12.6	39±11	20	20	SVV>12	①②⑤
伍淑韫 2020^[14]	18~65		30	30	PPV>13	②⑤
吴洁 2017^[15]	50±9	50±9	33	30	SVV>12	⑤
张杰 2012^[16]	42±12	42±10	20	20	SVV>13	①②⑤
易勇 2016^[17]	53±4.8	52.5±4.9	53	53	SVV>13	②④⑤⑥
潘晓燕 2017^[18]			58	57	ITBVI:800~1000 ml/m²	③④⑦⑧
王学飞 2016^[19]	39.6±3.6	40.1±4.2	27	25	SVV>12	①②③④
王德勇 2019^[20]	60.13±12.31	60.21±12.24	25	25	ITBVI:800~1000 ml/m²	⑤⑥
王慧霞 2021^[21]	40.96±2.29	41.87±2.42	48	47	SVV>13	②⑧
田胜兰 2015^[22]	54.7±4.2	52.5±6.3	12	12	SVV>12	①②③④
莫朴 2015^[23]	43.2±9.7		40	40	ITBVI:800~1000 ml/m²	②⑥
袁柳青 2013(心指数)^[24]	18~60		14	12	ITBVI:800~1000 ml/m²	①⑥
袁柳青 2013(脑氧代谢)^[25]	47.3±11.1	49.8±10.3	14	12	ITBVI:800~1000 ml/m²	③④⑤
袁柳青 2020(vigileo 监测)^[26]	47.1±11.2	45.3±12.4	20	20	SVV>13	⑦⑧
袁柳青 2020(基于每博变异)^[27]	46.4±8.2	45.7±8.1	23	23	SVV>13	①②⑦⑧
赵晓生 2019^[28]			19	19	SVV>13	⑦⑧