The Impact Of Allowed High SVV On Postoperative Delirium In Elderly Liver Surgery

Objective:To explore the impact of allowed high stroke volume variation(SVV)on postoperative delirium in elderly liver surgery.Methods:One hundred patients undergoing elective laparoscopic liver surgery in the affiliated hospital of Chengde Medical College hospital were randomly divided into two groups:the experimental group(groups)with SVV as the guide and the control group(group C)with CVP as the guide.Fifty patients were included in each of the two groups.Group S:Under the guidance of the target SVV value established;Group C:fluid therapy was performed based on the CVP value established intraoperatively.MAP,HR and oxygen consumption rate(O2ER)of patients at the time of entry(T1),skin resection(T1),initiation of liver resection(T2),commencement of liver resection(T,)and the completion of surgery(T4)were recorded.Note the operative time,intraoperative blood loss,fluid perfusion,and urine output.Note the lactic acid concentration at T0 and T4.Continuous recording of regional cerebral minimum intraoperative rSO2value(rSO2min),and the maximum percentage of rSO2decrease from the basic value(rSO2%max).IL-6,TNF-α and CRP were detected pre-surgery and 1 day post-surgery:The level of S100β protein and neuron-specific enolase(NSE)in the peripheral blood was detected at 1 day pre-surgery and 1 day post-surgery and 3 days post-surgery.CAM scores were performed pre-surgery and on day 1,3,7 post-surgery,severally,and the occurrence of POD and hospitalization days in the two groups were recored.Results:The MAP in group S at T2-3,was significantly greater than that in group C,and the HR was significantly lower than that of group C.The difference was statistically significant(P<0.05).The amount of intraoperative blood loss in group S was significantly less than that in group C,and the amount of intraoperative fluid and urine was significantly greater than that in group C.The difference was found to be statistically significant(P<0.05).The serum lactic acid concentration in T4 of group S was significantly greater than group C,and the difference was found to be statistically significant(P<0.01).Operation time and pre-operative serum lactic acid between were not significantly different between the 2 groups(P>0.05).At T2-4,the rSO2%max of group S was significantly lower than that of group C,and the difference was found to be statistically significant(P<0.05);the rSO2minand rSO2 were not statistically significant between the two groups(P>0.05).At T2-4,the O2ER of in group S was lower than that in group C,and the difference was found to be statistically significant(P<0.05).The expressions of S100βprotein and NSE in the plasma of 2 groups were significantly increased postoperatively.The S100β protein and NSE in group C were significantly higher than those in group S 1d and 3d postoperatively,and the difference was statistically significant(P<0.05).However,the length of hospital stay,the incidence of POD in group S were significantly less than those in group C,and the difference was statistically significant(P>0.05).The duration of hospitalization in groupS was significantly less than that in group C,and the difference was statistically significant(P<0.05).Conclusion:Permissible-high SVV optimizes fluid therapy in elderly patients with laparoscopic hepatectomy,alleviates inflammatory response,guarantees cerebral perfusion,reduces cerebral oxygen metabolism,and reduces the occurrence of POD.