关键词: 每搏变异度, 精准肝叶切除, 容量管理

Abstract:

Objective To investigate the effect of stroke volume variation （SVV）as an index of volume administration in hepatolobectomy. Methods Sixty patients undergoing hepatolobectomy were assigned to two groups，the observation group（Group S，CVP weas maintained at 0-5 cm H2O and SVV maintained at 10±2%）and the control group （Group C ，CVP was maintained at 0-5 cm H2O）. The hemodynamics of two groups of patients were recorded at certain time points ，including the 30 minutes after anesthesia（T1），the end time of hepatectomy（T2），and the end time of operation（T3）. The hemo? globin （Hb），blood cell volume （HCT），creatinine （Cr） and urea nitrogen （Bun） levels of the two groups were recorded the day before the operation（A），the first day after hepatectomy（B）and the day after the operation（C）. The operation time，amount of bleeding and urine，the recovery time of gastrointes? tinal function，the length of hospital stay and the incidence rate of complications of the two groups were recorded. Results There were no significant differences in gender，age，body weight and liver function between the two groups. The comparison of blood flow dynamics of the two groups of patients at T1 ，T2 and T3 had no statistically significant difference in Group S patients. There was no significant difference in  invasive blood pressure（ABP）and central venous pressure（CVP）in Group C patient；there was significant difference in cardiac output（CO）and heart rate（HR）T2，T3 and T1 comparisons（P<0.05）. There was no significant difference in the preoperative and postoperative laboratory indexes of Group S（P>0.05）. There was no significant difference in the level of urea nitrogen（P>0.05）；there was significant difference in hemoglobin，blood cell pressure and creatinine levels in Group C patients（P<0.05）. The clinical data of the two groups showed little change in urine volume；the liver cutting time，blood loss，intraoperative fluid，gastrointestinal recovery time，hospitalization time and complications showed significant difference in the incidence rate（P<0.05）. Conclusion Liver resection operation under SVV dynamic guidance capacity management is conducive to the control of intraoperative bleeding and reduction blood loss， shortens the operation time，optimizes the individualized rehydration.

Key words: volume management, stroke volume variation, precise hepatectomy