To investigate the effect of goal-directed fluid management strategy on tissue perfusion and stress response in patients undergoing laparoscopic hepatectomy (LH).

The clinical data of 58 patients with LH hepatocellular carcinoma admitted to the 80th Group Military Hospital of the Chinese People's Liberation Army from January 2018 to June 2021 were prospectively analyzed. They were divided into routine group (30 cases) and goal-directed group (28 cases) according to different fluid management strategies. Routine liquid management strategy was used in the routine group and goal-directed fluid management strategy was used in the goal-directed group. The perioperative parameters, hemodynamics and tissue perfusion parameters, stress response parameters and liver and kidney function parameters were compared between the two groups.

Compared with the routine group, the intraoperative blood loss, colloidal fluid volume, total infusion volume, urine output, postoperative exhaust time and postoperative hospital stay were significantly reduced in the goal-directed group (t=1.807, 2.008, 2.274, 4.492, 1.888, 2.146; all P<0.05) and the amount of crystalloid increased significantly (t=-4.399, P<0.001), and the differences were statistically significant. There was no interaction between time and method on HR, MAP, CVP, ScvO₂, Lac and Glu, but the main effect of time and method on HR, MAP, CVP, ScvO₂, Lac and Glu was significant (P<0.05). 1 day after surgery, the levels of E, IL-6 and CRP in both groups were significantly higher than those before surgery (P<0.05), and the levels of E, IL-6 and CRP in the goal-directed group were significantly lower than those in the routine group (P<0.05). The levels of CD4⁺ and CD4⁺/CD8⁺ in both groups were significantly decreased compared with those before surgery (P<0.05), and the levels of CD4⁺ and CD4⁺/CD8⁺ in the goal-directed group were significantly higher than those in the routine group (P<0.05). There was no interaction between time and method on ALB, TBil, AST, ALT, BUN and Cr. The main effect of time and method on ALB, TBil, AST and ALT was significant (P<0.05), while the main effect of time and method on BUN and Cr was not significant.

In LH, the goal-directed fluid management strategy can effectively reduce intraoperative injury, maintain hemodynamic stability and immune function, ensure adequate tissue perfusion, maintain the immune function of the body, protect liver function and accelerate postoperative recovery of patients.