Application Of Goal-Directed Fluid Therapy With Low Central Venous Pressure Combined With Stroke Volume Variability In Laparoscopic Partial Hepatectomy

Backgroud and ObjectivesLaparoscopic partial hepatectomy has become an effective method for treating benign and malignant diseases of the liver,but due to the anatomy of the liver and its complexity,bleeding is an important factor affecting the effect of surgery.Therefore,effective control of the amount of bleeding during liver parenchymal dissection and effective fluid management measures have become an important task in the field of liver surgery.Controlled lower central venous pressure(CLCVP)can improve the safety and effectiveness of liver surgery,thereby improving patient survival.However,in recent years,many studies have found that central venous pressure(CVP)is a static parameter,which is affected by pneumoperitoneum and body position,and has poor sensitivity and specificity.Goal-directed fluid therapy(GDFT)guided by stroke volume variation(SVV)can more precisely guide fluid replacement during partial hepatic resection.SVV has strong sensitivity and specificity,and can accurately predict the body’s response to liquids under mechanical ventilation.However,the target value of SVV in laparoscopic partial hepatic resection remains to be explored.To investigate the safety of goal-directed fluid therapy with CLCVP in combination with different SVVs in laparoscopic partial hepatic resection and to evaluate its effect on short-term prognosis.MethodsSixty patients were randomly assigned to group A and group B for electi ve laparoscopic partial hepatectomy.Intraoperative fluid management is carried out in two phases.The first stage:the beginning of surgery to the completion of the liver cross-section,and the second stage:the completion of the liver cr oss-section to the end of the operation.The first stage:group A maintained SV V(7%～12%),CVP5<cmH2O;group B maintained SVV(13%～8%),CVP<5c mH2O.The second stage:Groups A and B are goal-oriented with CVP≧5cm H2O,SVV<13%.The main observation measure of this study was total intrao perative blood loss.The hemodynamics of the supine position(T0),after pneu moperitoneum(T1),after postural adjustment(T2),during hepatic resection(T 3),after mass resection(T4),after pneumoperitoneum(T5),and after postural callback(T6)were recorded.Analysis of blood gas before the start of surgery(10),after mass removal(I1),and before exit(I2);Record blood routine,liver and kidney function before surgery(D0),postoperative day 1(D1),postoperati ve day 3(D2),and postoperative day 7(D3).ResultsA total of 58 cases were observed.There was no significant difference in general data between the two groups(P>0.05).Compared with the hemodynamic indexes of T0,CVP increased at T1(P<0.05)and decreased at T2,T3,T4 and T5(all P<0.05).SVV in T1,T2,T3 and T4 increased but decreased at T5 and T6(all P<0.05).SVV in group B was higher than that in group A(all P<0.05)at all time points,and T2 CVP in group A was higher than that in group B(P<0.05).Compared with DO CRP,CRP in D1,D2 and D3(all P<0.05)was increased.There was no significant significance in liver and kidney function and infection indexes between the two groups(all P>0.05).There were no significant differences in total blood loss,crystalline colloidal volume,operation time,maximum amount and dosage of norepinephrine,length of hospital stay and cost between the two groups(all P>0.05).ConclusionsIn laparoscopic partial hepatectomy,controlled low central venous pressure combined with stroke volume variation is used as goal-directed fluid therapy,which provides patients with individualized and precise fluid therapy strategies,maintains good hemodynamic status,and has no effect on postoperative liver and kidney function.