以每搏量变异度为指导的液体治疗在腹腔镜精准肝切除术中的应用

目的：观察以每搏量变异度(stroke volume variation，SVV)为指导的目标导向液体治疗(goal-directed fluidtherapy，GDFT)在腹腔镜精准肝切除术中的安全性及对患者短期预后的影响。方法：120例18~65岁择期全麻下行腹腔镜精准肝切除术患者，随机分为以SVV为指导的治疗组(S组)和以中心静脉压为指导的治疗组(C组)，每组60例。记录入室(T0)、切皮(T1)、始切肝(T2)、肝横断面完成(T3)、术毕(T4)的平均动脉压和心率，T0~T5(术后1 d)的乳酸值(lactic acid value，LAC)，术中出入量及低血压和去氧肾上腺素使用情况，术后肝功能、血红蛋白等恢复情况。结果：与C组比较，S组术中低血压例数、出血量、去氧肾上腺素用量均明显降低(P<0.05)，T3和T4时间点LAC升高不明显(P<0.05)，术后1和2 d的AST，ALT，DBIL，TBIL升高幅度明显降低(P<0.05)。S组术后1 d血红蛋白、红细胞压积明显高于C组(P<0.05)，术后排气时间、住院时间明显缩短(P<0.05)，感染率和入住ICU率均降低(P<0.05)。结论：腹腔镜精准肝切除术中以SVV为指导的目标导向液体治疗安全、有效，可减少术中失血量，利于患者短期预后。切肝期采用高SVV值(13%~17%)，横断面离断至术毕采用8%~12% SVV值可作为术中液体治疗策略之一。

Application of stroke volume variation-guided liquid therapy in laparoscopic precision hepatectomy

Objective: To observe the safety and impact on the short-term prognosis for patients of strokevolume variation (SVV) goal-directed fl uid therapy (GDFT) in laparoscopic precision hepatectomy.Methods: A total of 120 patients (18–65 years old) undergoing laparoscopic precision hepatectomywere randomly divided into the fl uid therapy group (group S) guided by SVV and the fl uid therapygroup (group C) guided by central venous pressure group (CVP), with 60 cases in each group.Mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time: at homecalm (T0), the operation started (T1), began to cut the liver (T2), the hepatectomy was acheived(T3), and in the end (T4). The lactic acid was measured at T0 to T4 and 1 day after surgery (T5).The amount of blood loss, urine output and fluid supplement, the incidence of intraoperativehypotension, and the use of neophryn were recorded. The recovery of liver function, Hb, and so onwere also recorded.Results: Compared with the group C, the number of hypotension cases, the amount of blood lossand the amount of neophryn in the group S were decreased during the operation (P<0.05), whilethe lactic acid values in the group S were not significantly increased than those in the group C at T3and T4 (P<0.05) and the elevation of AST, ALT, DBIL and TBIL in the group S was significantlydecreased than those in the group C at 1 and 2 d after the operation (P<0.05). Hb and Hct in thegroup S were higher than those in the group C at 1 d after the surgery (P<0.05). Compared withthe group C, the postoperative exhaust time and hospitalization time were shortened in the group S(P<0.05), and the infection rate and ICU admission rate were decreased in the group S (P<0.05).Conclusion: SVV-guided GDFT in laparoscopic precise hepatectomy is safe and effective. Itreduces intraoperative blood loss and benefits the short-term prognosis of patients after operations.High SVV value (13%–17%) is adopted at the liver resection stage, and SVV value with 8%–12% atthe end of trans-section may be used as one of intraoperative liquid therapy in laparoscopic precisehepatectomy.