Application Of Goal-directed Fluid Therapy Based On SVV In Elderly Patients Undergoing Open Hepatectomy

Objective To investigate the application effects of goal-directed flu id therapy?GDFT?guided by stroke volume variation?SVV?on elder ly patients undergoing open hepatectomy.Methods Sixty elderly patients??60years?undergoing elective open hepatectomy were randomly and equally assigned to two groups,t o receive the controlled low central venous pressure?CLCVP?techn ique?CLCVP group?and SVV-guided GDFT?GDFT group?respecti vely during operation.Hemodynamic and blood gas indexes were c ompared between the two groups at 5 time points:5 min before an esthesia induction?T0?,immediately entering the abdominal cavity?T1?,the second hepatic blood flow occlusion?T2?,starting closure of abdomen?T3?,and operation completion?T4?.Other variables s uch as intraoperative blood loss,amount of fluid infusion,urine vol ume,operation time and time of hepatic blood flow occlusion were also compared.Results The general date of the two groups of patients were comp arable.Compared with the hemodynamic variables at T0 time point within group,the mean arterial pressure?MAP?were decreased at T1,T2,T3 and T4 time points,the heart rates?HR?were reduced at T1 time point in both groups,central venous pressure?CVP?were decreased at T1and T2 time points in CLCVP group and and decr eased at all T1,T2,T3 and T4 time points in GDFT group?all P<0.05?,and the cardiac index?CI?was increased at T2,T3 and T4 ti me points in GDFT group.The MAP and HR showed no significant differences between the two groups at any time point?all P>0.05?,but the CVP at T2 time point,CI at T2,T3 and T4 time points i n GDFT group were higher than those in CLCVP group?all P<0.05?,and the CVP at T3?T4 in GDFT group were decreased than tho se in CLCVP group?all P<0.05??Compared with the blood gas va riables at T0 time point within group,the blood pH values were dec reased in both groups at T2,T3 and T4 time points?all P<0.05?,t he central venous oxygen saturation(S_CVO₂)showed no significant differences in CLCVP group at each time point?all P>0.05?,but w as increased at T2,T3 and T4 points in GDFT group?all P<0.05?,and the blood lactic acid?Lac?levels were significantly increased at all T1,T2,T3 and T4 time points in both group?all P<0.05?.T he pH values showed no significant differences between the two gr oups at any time point?all P>0.05?,but the S_CVO₂ values were hig her at T2,T3 and T4 time points and the Lac levels were lower at T3 and T4 time points in GDFT group than those in CLCVP gro up?all P<0.05?.There were no statistically significant differences b etween the two groups in the amounts of crystal fluid,colloidal flu id,total fluid and urine volume and operation time?all P>0.05?,but The amount of fluid in GDFT group was higher than CLCVP grou p at the completion of liver parenchymal detachment,the intraoperati ve blood loss and time of hepatic blood flow occlusion were reduc ed in GDFT group compared with CLCVP group?both P<0.05?.Conclusion:In elderly patients undergoing open hepatectomy,using SVV-guided GDFT can stabilize the hemodynamic status,improve t he blood gas indexes and reduce intraoperative hemorrhage and the time of liver blood flow occlusion.