Effects Of Pleth Variability Index Combined With Controlled Low Central Venous Pressure On Inflammatory Cytokine And Hepatic And Renal Function During Perioperative Period Of Hepatectomy

Objective:To explore the effects of Pleth variability index combined with controlled low central venous pressure on inflammatory cytokine and hepatic and renal function during perioperative period of hepatectomyMethods:100 patients aged 40 to 70 years who underwent hepatectomy in our hospital from March 2019 to September 2020,ASA II-III,Child-Pugh score A to B,were randomly divided into two groups:low central venous pressure group（group C）,maintained CVP 0～5cm H₂O during hepatectomy;CVP 6～12cm H₂O was recovered by rapid fluid replacement after liver resection.PVI guided GDFT combined with CLCVP group（group P）:CVP 0～5cm H₂O and PVI<14%during hepatectomy;Rapid fluid rehydration under the guidance of PVI after hepatectomy,CVP 6～12cm H₂O,PVI<14%.maintained MAP≥65mm Hg and urine volume greater than 25ml/h in both groups.obvervational index:（1）Baseline data of the two groups;（2）Perioperative fluid intake,such as crystal fluid intake,colloid fluid intake,blood transfusion volume,total fluid rehydration,urine volume,blood loss and abdominal drainage volume;（3）Perioperative observation indicators:First hepatic portal block time,operation time,extubation time,post-anesthesia monitoring and treatment room time,alert/sedation score,exhaust time,length of hospital stay;（4）Hemodynamics and volume indexes included HR,MAP,CVP,PVI and PI 6 min before induction（T0）,after induction（T1）,6 min before hepatic parenchyma separation（T2）,6 min after liver resection（T3）,and after operation（T4）.（5）inflammatory cytokines, including plasma,endotoxin,procalcitonin,C-reactive protein,neutrophils to lymphocyte ratio,platelet to lymphocyte ratio,1 and 3 days before and after surgery;（6）Liver and kidney function,such as ALT,AST,T.Bil,BUN,Cr;（7）Blood gas analysis indexes such as p H,PCO₂,HCO₃^-,Lac,HbResults:（1）The general situation between the two groups was not statistically significant（all P>0.05）;（2）The amount of crystalloid fluid and total infusion of children in group P were lower than those of group C,and the amount of colloidal fluid was higher than that of group C.The differences were statistically significant（P<0.01）;（3）the extubation time and exhaust time in group P were less than those in group C（P<0.01）;（4）Comparison between groups:The CVP of group P was higher than that of group C at T1～T3（P<0.01）;The PVI at T4 in group P was lower than that in group C（P<0.01）;PI in group P was higher than that in group C at T1～T4（P<0.01）.Intra-group comparison:Heart rate of the two groups decreased gradually from T1 to T3,and increased at T4（P<0.01）;Mean arterial pressure in the two groups decreased gradually from T1-T3 and increased at T4（P<0.01）;The CVP of both groups was decreased from T1 to T2,and increased gradually from T3 to T4（P<0.01）;PVI in group C decreased gradually from T2 to T4,and PVI in group P decreased gradually from T1 to T4（P<0.01）;PI in P group increased gradually from T1 to T4（P<0.01）;（5）Comparison between groups:LPS and CRP of group P were lower than those of group C on the first and third day after surgery（P<0.01）;PCT and PLR of group C was higher than that of group P on postoperative day 3（P<0.01）.Intra-group comparison:LPS,PCT,CRP,PLR and NLR of 2 groups on the 1st and 3rd days after surgery were all higher than those on the 1st day before surgery,which basically increased first and then decreased（P<0.05）;（6）Comparison between groups:AST on the first day after surgery and BUN on the third day after surgery in group P were lower than those in group C（P<0.01）.Intra-group comparison:ALT and T.Bil increased in both groups on the first and third day after surgery（P<0.05）,AST and BUN of group C were increased on postoperative day 1 and 3（P<0.01）,and the Cr of P group on the first and third day after surgery was firstly increased and then decreased（P<0.01）;（7）Comparison between groups:The p H and Lac of group P were lower than those of group C（P<0.01）.Intra-group comparison:the Hb of the two groups on the 1st and 3rd days after surgery were firstly decreased and then increased,PCO₂was firstly increased and then decreased,Lac was gradually increased,and p H was gradually decreased（P<0.05）Conclusion:PVI guidance GDFT combined with controlled low central venous pressure in hepatectomy can decrease intraoperative crystal input,infusion volume,increase input,shortening the time of decannulation time and exhaust,maintain effective circulating blood volume,improve tissue perfusion and oxygen supply and demand balance,inhibit the body’s inflammatory response and reduce the postoperative lactic acid levels,protect the liver and kidney function,beneficial to patients’rapid recovery.