Comparative study of perioperative fluid management in elderly patients with hepatocellular carcinoma complicated with cirrhosis in laparoscopic hepatectomy

doi:10.3877/cma.j.issn.1674-0793.2022.03.008

Abstract

Abstract:

Objective

To investigate the effect of different perioperative fluid management in laparoscopic hepatectomy in elderly patients with hepatocellular carcinoma complicated with cirrhosis and its effect on hemodynamics and immune stress.

Methods

A total of 86 elderly patients with hepatocellular carcinoma complicated with cirrhosis who underwent hepatectomy were prospectively selected from Shanghai Baoshan District Hospital of Integrated Traditional Chinese Medicine and Western Medicine from June 2019 to May 2021. The patients were divided into controlled lower central venous pressure (CLCVP) group and goal-directed fluid therapy (GDFT) group by random number table method, with 43 cases in each group. Intraoperative fluid infusion was performed in the CLCVP group guided by CLCVP, and GDFT guided by SVV was performed in the GDFT group . The perioperative indexes and postoperative complications were observed. Hemodynamics and blood gas indexes of the two groups were detected before anesthesia induction (T1), 5 min before hepatectomy (T2), 5 min after hepatectomy (T3) and at the end of surgery (T4). The changes of stress index and cellular immunity index before and after operation were observed.

Results

Intraoperative blood loss, hepatic blood flow occlusion time, gastrointestinal function recovery time and hospital stay in GDFT group were significantly better than CLCVP group (t=2.044, 2.229, 3.637, 2.410, all P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (30.2% vs 20.9%, χ²=0.943, P=0.331). The cardiac index (CI) in GDFT group was significantly higher than that in CLCVP group at T3 and T4 (P<0.05). The central venous pressure (CVP) at T3 was higher than that in CLCVP group (P<0.05), and at T4 was lower than that in CLCVP group (P<0.05). Central venous oxygen saturation (ScvO₂) at T3 and T4 was higher than that in CLCVP group (P<0.05). Lactic acid at T4 was lower than that in CLCVP group (P<0.05). The levels of Cor, IL-6 and TNF-α in GDFT group were lower than those in CLCVP group at 3 d and 7 d after surgery (P<0.05). The levels of CD4+, CD8+ and CD4+/CD8+ in GDFT group were higher than those in CLCVP group at 7 d after surgery (P<0.05).

Conclusion

GDFT guided by SVV can stabilize intraoperative hemodynamics, improve immune stress, reduce intraoperative bleeding and hepatic blood flow blocking time, and is more conducive to postoperative recovery of elderly patients with liver carcinoma complicated with cirrhosis during hepatectomy.

Key words: Controlled lower central venous pressure, Goal-directed fluid therapy, Liver carcinoma with cirrhosis, Laparoscopic hepatectomy

Zhujie Gu, Shuangshuang Hu, Xiaowei Shi, Yu Ma, Minmin Lu, Jiansheng Wang. Comparative study of perioperative fluid management in elderly patients with hepatocellular carcinoma complicated with cirrhosis in laparoscopic hepatectomy[J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(03): 199-204.

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References 16

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组别	例数	年龄(岁)	性别	肿瘤直径(cm)	ASA分级	心功能分级	肝硬化程度	Child-Pugh分级
组别	例数	年龄(岁)	男/女	肿瘤直径(cm)	Ⅱ/Ⅲ	Ⅰ/Ⅱ	轻/中/重	A/B
CLCVP组	43	67.4±6.3	30/13	4.1±0.7	31/12	28/15	16/20/7	35/8
GDFT组	43	65.9±7.6	27/16	3.9±0.8	29/14	30/13	15/19/9	32/11
统计值		0.996^a	0.468^b	1.234^a	0.221^b	0.212^b	-0.421^c	0.608^b
P值		0.322	0.494	0.221	0.639	0.645	0.674	0.436

组别	例数	年龄(岁)	性别	肿瘤直径(cm)	ASA分级	心功能分级	肝硬化程度	Child-Pugh分级
组别	例数	年龄(岁)	男/女	肿瘤直径(cm)	Ⅱ/Ⅲ	Ⅰ/Ⅱ	轻/中/重	A/B
CLCVP组	43	67.4±6.3	30/13	4.1±0.7	31/12	28/15	16/20/7	35/8
GDFT组	43	65.9±7.6	27/16	3.9±0.8	29/14	30/13	15/19/9	32/11
统计值		0.996^a	0.468^b	1.234^a	0.221^b	0.212^b	-0.421^c	0.608^b
P值		0.322	0.494	0.221	0.639	0.645	0.674	0.436

组别	例数	手术时间(min)	术中出血量(ml)	总补液量(ml)	肝血流阻断时间(min)	胃肠功能恢复时间(d)	住院时间(d)
CLCVP组	43	189.2±36.4	316.2±71.6	1 624.6±283.2	43.2±7.6	3.1±0.9	8.1±2.5
GDFT组	43	182.7±31.5	287.4±58.4	1 598.4±239.5	39.8±6.5	2.5±0.6	6.9±2.1
t值		0.886	2.044	0.463	2.229	3.637	2.410
P值		0.378	0.044	0.644	0.029	0.001	0.018

组别	例数	手术时间(min)	术中出血量(ml)	总补液量(ml)	肝血流阻断时间(min)	胃肠功能恢复时间(d)	住院时间(d)
CLCVP组	43	189.2±36.4	316.2±71.6	1 624.6±283.2	43.2±7.6	3.1±0.9	8.1±2.5
GDFT组	43	182.7±31.5	287.4±58.4	1 598.4±239.5	39.8±6.5	2.5±0.6	6.9±2.1
t值		0.886	2.044	0.463	2.229	3.637	2.410
P值		0.378	0.044	0.644	0.029	0.001	0.018

组别	例数	时间	MAP(mmHg)	CVP(cmH₂O)	HR(次/分)	CI[L/(min·m²)]	ScvO₂ (%)	Lac(mmol/L)
CLCVP组	43	T1	95.5±7.3	8.7±1.8	78.4±8.5	2.8±0.3	70.3±4.4	0.8±0.2
		T2	89.6±7.6^a	4.9±1.7^a	74.6±6.2^a	3.1±0.4	71.2±3.5	1.2±0.3^a
		T3	88.7±8.4^a	3.2±1.2^a	76.4±6.9	2.8±0.5	71.3±2.9	1.4±0.4^a
		T4	87.6±8.5^a	8.4±1.6^a	77.1±7.2	2.9±0.6	71.2±2.7	1.7±0.4^a
GDFT组	43	T1	94.7±8.5	8.5±2.2	78.9±8.8	2.8±0.4	70.5±3.9	0.8±0.3
		T2	88.9±9.4^a	5.1±1.5^a	74.1±5.9^a	2.9±0.5	71.6±3.1	1.1±0.2^a
		T3	88.1±9.7^a	4.1±1.6^ab	75.9±6.6	3.1±0.3^ab	73.4±3.4^ab	1.4±0.3^a
		T4	88.9±8.3^a	6.3±1.8^ab	77.4±6.8	3.2±0.4^ab	73.4±3.2^ab	1.5±0.3^ab

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