RESUMO
Objective:To evaluate the effect of goal-directed fluid therapy (GDFT) based on permissive high stroke volume variation (SVV) guidance on residual liver function in elderly patients undergoing laparoscopic hepatectomy.Methods:A total of 100 elderly patients of either sex, aged 65-80 yr, with body mass index of 18.5-24.9 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Child-Pugh grade A or B, scheduled for elective laparoscopic hepatectomy, were divided into 2 groups ( n=50 each) by the random number table method: SVV-guided GDFT group (group SG) and CVP-guided fluid replacement group (group C). Intraoperative fluid management was divided into 2 stages.The first stage was from the start of surgery to the completion of liver resection, the SVV was maintained at 13%-20% in group SG, and the low CVP was maintained at 0-5 cmH 2O in group C. The second stage was from completion of liver resection to the end of the operation, SVV was maintained at 9%-13%, additional hydroxyethyl starch 3 ml/kg was given or repeatedly administered when SVV>13% (for 5 min) or when the response to previous fluid replacement was positive (SVV increased by more than 10%), and the infusion rate was slowed down when the SVV was 9%-13% in group SG, and CVP was maintained at 5-12 cmH 2O in group C. Mean arterial pressure and heart rate were recorded on admission to the operating room, at skin incision (T 1), at the start of liver resection (T 2), at completion of liver resection (T 3) and at the end of operation (T 4). The operation time, intraoperative blood loss, transfusion volume, urine volume and levels of serum lactic acid before operation and at the end of operation were recorded.Blood samples from the median cubital vein were collected at T 0-4 to measure blood glucose and cortisol concentrations.The concentrations of serum aspartate aminotransferase, alanine aminotransferase, total bilirubin and albumin were measured before operation, at 1, 3 and 5 days after operation, and prothrombin time, activated partial thromboplastin time, thrombin time and Fib were recorded.The concentrations of serum interleukin-6, tumor necrosis factor-alpha and C-reactive protein were measured by enzyme-linked immunosorbent assay before operation and at the end of operation, and the postoperative complications and length of hospital stay were recorded. Results:Compared with group C, mean arterial pressure and heart rate were significantly decreased at T 2, 3, blood loss was reduced, transfusion volume and urine volume were increased, prothrombin time and activated partial thromboplastin time were shortened at the end of operation, serum concentrations of interleukin-6 and lactic acid and concentrations of aspartate aminotransferase and alanine aminotransferase in serum at 5 days after operation were decreased, and the length of hospital stay was shortened in group SG ( P<0.05). Conclusions:GDFT based on permissive high SVV guidance can improve residual liver function in elderly patients undergoing laparoscopic hepatectomy.
RESUMO
Objective:To evaluate the effect of permissive high stroke volume variability (SVV) on postoperative delirium (POD) in elderly patients undergoing laparoscopic hepatectomy.Methods:A total of 100 elderly patients of either sex, with body mass index of 18.5-24.9 kg/m 2, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Child-Pugh grade A or B, scheduled for elective laparoscopic hepatectomy, were divided into 2 groups ( n=50 each) using a random number table method: permissive high SVV group (group S) and control group (group C). Group S was given goal-directed fluid infusion with a target of high SVV (13%-20%), and fluid replacement was performed according to the intraoperative CVP in group C. Oxygen extraction ratio was calculated on admission to the operating room (T 0), at skin incision (T 1), at the beginning of liver resection (T 2), completion of liver resection (T 3) and at the end of operation (T 4). Intraoperative blood loss, volume of fluid infused and urine volume were recorded.Lactic acid concentrations were measured at T 0 and T 4.Regional cerebral oxygen saturation (rSO 2) was continuously recorded, and the maximum percentage of decrease in rSO 2 from baseline (rSO 2max%) was calculated.Peripheral venous blood samples were collected at 1 day before operation, at the end of operation, and at 1 and 3 days after operation to determine the concentrations of serum S100β and neuron-specific enolase.POD was evaluated at 1, 3 and 7 days after operation, and the hospitalization time was recorded. Results:Compared with group C, the intraoperative blood loss was significantly decreased, the volume of fluid infused and urine volume were increased, the lactic acid concentration at T 4, rSO 2max%, oxygen extraction ratio at T 2-4, serum S100β and neuron-specific enolase concentrations and incidence of POD at 1 and 3 days after operation were decreased, and the hospitalization time was shortened in group S ( P<0.05). Conclusion:Permissive high SVV can decrease the development of POD in elderly patients undergoing laparoscopic hepatectomy, which is related to reduction of cerebral oxygen metabolism.