Effect Of Goal-directed Fluid Therapy Combined With Controlled Low Central Venous Pressure On Postoperative Outcome In Patients Undergoing Precision Liver Resection

Objective To investigate the effect of goal-directed fluid therapy combined with low central venous pressure by using stroke volume variation on intraoperative blood loss and postoperative outcome in patients undergoing precision liver resection.Methods Seventy-five patients scheduled for precision liver resection were randomly divided into the control group(group C,n=25),the low central venous pressure group(group L,n=25),the goal-directed fluid therapy combined with low central venous pressure group(group G,n=25).All patients were adopted intravenous anesthesia to induction and intraoperative maintenace.Patients in group L and group G were maintained central venous pressure(CVP)? 0.49 KPa by the methods of adjusting the position and infusing nitroglycerin or furosemide during the time of liver resection,the CVP of the patients in group C was not intervened.Arterial blood gas was analyzed at five minutes before anesthesia induction(T0),five minutes before liver resection(T1),five minutes after liver resection(T2),at the end of surgery(T3),which included the values of PH,Base excess(BE),HCO3-,PCO2 and Blood lactic acid(LAC).Mean arterial pressure(MAP),heart rate(HR)and CVP were recorded at the four time points above.Gender,age,body height,body weight,the class of Child-Pugh,the class of American society of anesthesiologists(ASA),the number of hepatitis B virus carrier,operation time,the first porta hepatis occlusion time,fluid infusion volume,urine volume,intraoperative blood loss volume,intraoperative blood infusion cases,the largest diameter of the tumor,the weight of the tumor were recorded,post anesthesia care unit(PACU)stay time,recovery time of postoperative gastrointestinal function, acute kidney injury,postoperative nausea and vomiting(PONV),postoperative pulmonary complications(POPC),postoperative length of hospital stay,total length of hospital stay were observed.Results Comparison of details There were no significant differences in age,height and weight among three groups.(P > 0.05).Comparison of haemodynamic variables Compared with T0 time point,the CVP values of group L reduced in the T1~2 time points(P < 0.01),the CVP values of group G reduced in the T1~2 time points(P < 0.01),the MAP values of group L reduced in the T1~3 time points(P < 0.01),the MAP values of group G reduced in the T2 time points(P < 0.01),Compared with group C,the CVP values of group L reduced in the T1~2 time points(P < 0.01),the CVP values of group G reduced in the T1~2 time points(P < 0.01),the HR values of group L reduced in the T1~2 time points(P < 0.01),the HR values of group G reduced in the T1~2 time points(P < 0.01).there was no significant difference in the MAP values of group L(P > 0.05),there was no significant difference in the MAP values of group L(P > 0.05).Compared with group L,there were no significant differences in the MAP,HR and CVP of group G(P > 0.05).Comparison of blood gas results Compared with T0 time point,the PH values of group C reduced in the T1~3 time points(P < 0.01),the PH values of group L reduced in the T1~3 time points(P < 0.01),the PH values of group G reduced in the T1~3 time points(P < 0.01),the LAC values of group C increased in the T3 time point(P < 0.05),the LAC values of group L increased in the T2~3 time points(P < 0.01),the LAC values of group C increased in the T2~3 time points(P < 0.01)Compared with group C,there were no significant differences in the PH values,LAC values and BE values of group L(P > 0.05),there were no significant differences in the PH values,LAC values and BE values of group G(P > 0.05).Compared with group L,there were no significant differences in the PH values,LAC values and BE values of group G(P > 0.05).Comparison of complications and recovery time There were no significant differences in results of intraoperative blood loss volume,intraoperative blood infusion cases,postoperative nausea and vomiting,acute kidney injury,postoperative pulmonary complications among three groups(P > 0.05).Compared with group C,there were no significant differences in the recovery time of postoperative gastrointestinal function,the length of hospital stay,the total length of hospital stay of group L(P > 0.05),Compared with group C,there were significant differences in the fluid infusion volume,the recovery time of postoperative gastrointestinal function postoperative,the length of hospital stay,the total length of hospital stay of group G(P < 0.05),Compared with group L,there were significant differences in the fluid infusion volume,the recovery time of postoperative gastrointestinal function postoperative,the length of hospital stay,the total length of hospital stay of group G(P < 0.05).Conclusion In patients undergoing precision liver resection,the technique of goal-directed fluid therapy combined with low central venous pressure by using stroke volume variation can decrease the amount of intraoperative rehydration,shorten the recovery time of postoperative gastrointestinal function,postoperative length of hospital stay and total length of hospital stay.