The Application Of Goal-directed Fluid Therapy In Precise Hepatectomy

Objective To compare the difference between crystalloids and colloids under goal-directed fluid therapy(GDFT)in patients undergoing elective precise hepatectomy.Methods Seventy patients,ASA ? or ?,undergoing precise hepatectomy were included and randomly divided into three groups based on fluid treatment: conventional fluid therapy(group C,n=24),goal-directed fluid therapy using colloids(group G1,n=23)and goal-directed fluid therapy using crystalloids(group G2,n=23).After radical artery puncture and internal jugular vein puncture under local anesthesia,the Flotrac/Vigileo system was used to obtain stroke volume variation(SVV)and cardiac index(CI)in group G1 and group G2.Group C received conventional fluid therapy mainly based on MAP while group G1 and group G2 received goal-directed fluid therapy based on MAP,SVV and CI.250 m L colloids and 250 ml crystalloids were administered if the SVV was >13% respectively in group G1 and in group G2.If CI<2.5L/(min·m2),Dobutamine2.0~10mg ·kg-1·min-1 was given until CI>2.5L/(min·m2).HR,MAP,CVP,Scv O2,Lac and Glu was recorded at 5 min before anesthesia induction(T1),5 min before hepatectomy(T2),5 min after hepatectomy(T3)and the end of operation(T4).The duration of operation,fluid requirement,urinary output,bleeding volume,and the use of vasoactive agent were recorded.Preoperative and postoperative liver and kidney function test and postoperative complications were followed.Results There were no significant differences among the three groups for demographic data(P > 0.05).Compared with group C,the total volume was lower,the exhaust time,ambulation time and postoperative hospital stay was shorter,Lac at T2-T4 was lower,Scv O2 at T3 and T4 was higher,Glu at T3 and T4 was lower in group G1 and group G2(P <0.05).ALT and AST on the third day and the fifth day after surgery was lower in group G1 and group G2(P <0.05).Compared with group G1,The amount of crystalloids was increased,the incidence of postoperative nausea and vomiting was significantly higher in group G2(P < 0.05).There was no significant difference in exhaust time,ambulation time and postoperative hospital stay between group G1 and group G2(P>0.05).Conclusion GDFT in hepatectomy may improve the microcirculation and tissue oxygenation,protect liver function,promote gastrointestinal function recovery and shorten postoperative hospital stay.GDFT using colloids bolus contribute to a much lower incidence of postoperative nausea and vomiting.There was no significant difference in tissue perfusion and postoperative recovery between colloids and crystalloids.