摘要目的:评价允许性高SVV目标导向液体治疗(GDFT)对腹腔镜肝切除术老年患者残余肝功能的影响。方法:择期拟行腹腔镜肝切除术老年患者100例，性别不限，年龄65～80岁，BMI 18.5～24.9 kg/m 2，ASA分级Ⅱ或Ⅲ级，Child-Pugh分级A或B级。采用随机数字表法分为2组( n＝50)：SVV GDFT组(SG组)和CVP指导补液组(C组)。术中液体管理分2个阶段。第1阶段为手术开始至切肝完成，SG组维持SVV 13%～20%，C组维持低CVP 0～5 cmH 2O。第2阶段为切肝完成至手术结束，SG组维持SVV 9%～13%，SVV>13%时(持续5 min)或当前次补液试验反应为阳性时(SVV升高超过10%)，另给予3 ml/kg羟乙基淀粉，可重复使用，SVV为9%～13%时减慢输液速率。C组维持CVP 5～12 cmH 2O。于入室(T 0)、切皮(T 1)、开始切肝(T 2)、切肝完成(T 3)和术毕(T 4)时记录MAP和HR；记录手术时间、术中出血量、输液量、尿量、术前及术毕血清乳酸浓度；于T 0～4时抽取肘正中静脉血样，测定血糖和皮质醇浓度。术前、术后1、3和5 d时测定血清AST、ALT、TBIL和白蛋白浓度，记录PT、APTT、凝血酶时间和Fib；于术前和术毕时采用ELISA法测定血清IL-6、TNF-α和C反应蛋白浓度，记录术后并发症发生情况和住院时间。 结果:与C组比较，SG组T 2，3时MAP和HR降低，出血量减少，输液量和尿量增加，术毕PT和APTT缩短，血清IL-6和乳酸浓度、术后5 d时血清AST和ALT浓度降低，住院时间缩短( P<0.05)。 结论:允许性高SVV GDFT可改善腹腔镜肝切除术老年患者的残余肝功能。

abstractsObjective:To evaluate the effect of goal-directed fluid therapy (GDFT) based on permissive high stroke volume variation (SVV) guidance on residual liver function in elderly patients undergoing laparoscopic hepatectomy.Methods:A total of 100 elderly patients of either sex, aged 65-80 yr, with body mass index of 18.5-24.9 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Child-Pugh grade A or B, scheduled for elective laparoscopic hepatectomy, were divided into 2 groups ( n=50 each) by the random number table method: SVV-guided GDFT group (group SG) and CVP-guided fluid replacement group (group C). Intraoperative fluid management was divided into 2 stages.The first stage was from the start of surgery to the completion of liver resection, the SVV was maintained at 13%-20% in group SG, and the low CVP was maintained at 0-5 cmH 2O in group C. The second stage was from completion of liver resection to the end of the operation, SVV was maintained at 9%-13%, additional hydroxyethyl starch 3 ml/kg was given or repeatedly administered when SVV>13% (for 5 min) or when the response to previous fluid replacement was positive (SVV increased by more than 10%), and the infusion rate was slowed down when the SVV was 9%-13% in group SG, and CVP was maintained at 5-12 cmH 2O in group C. Mean arterial pressure and heart rate were recorded on admission to the operating room, at skin incision (T 1), at the start of liver resection (T 2), at completion of liver resection (T 3) and at the end of operation (T 4). The operation time, intraoperative blood loss, transfusion volume, urine volume and levels of serum lactic acid before operation and at the end of operation were recorded.Blood samples from the median cubital vein were collected at T 0-4 to measure blood glucose and cortisol concentrations.The concentrations of serum aspartate aminotransferase, alanine aminotransferase, total bilirubin and albumin were measured before operation, at 1, 3 and 5 days after operation, and prothrombin time, activated partial thromboplastin time, thrombin time and Fib were recorded.The concentrations of serum interleukin-6, tumor necrosis factor-alpha and C-reactive protein were measured by enzyme-linked immunosorbent assay before operation and at the end of operation, and the postoperative complications and length of hospital stay were recorded. Results:Compared with group C, mean arterial pressure and heart rate were significantly decreased at T 2, 3, blood loss was reduced, transfusion volume and urine volume were increased, prothrombin time and activated partial thromboplastin time were shortened at the end of operation, serum concentrations of interleukin-6 and lactic acid and concentrations of aspartate aminotransferase and alanine aminotransferase in serum at 5 days after operation were decreased, and the length of hospital stay was shortened in group SG ( P<0.05). Conclusions:GDFT based on permissive high SVV guidance can improve residual liver function in elderly patients undergoing laparoscopic hepatectomy.