Objective: To investigate the application effects of the goal-directed fluid therapy (GDFT) guided by stroke volume variation (SVV) on elderly patients undergoing open hepatectomy.
Methods: Sixty-four elderly patients (≥65 years) undergoing elective open hepatectomy were randomly and equally assigned to two groups, to receive the controlled low central venous pressure (CLCVP) technique (CLCVP group) and SVV-guided GDFT (GDFT group) respectively during operation. Hemodynamic and blood gas indexes were compared between the two groups at 5 time points: 5 min before anesthesia induction (T0), immediately entering the abdominal cavity (T1), the second hepatic blood flow occlusion (T2), starting closure of abdomen (T3), and operation completion (T4). Other variables such as intraoperative blood loss, amount of fluid infusion, urine volume and time of hepatic blood flow occlusion were also compared.
Results:  The general data of the two groups of patients were comparable. Compared with the hemodynamic variables at T0 time point within group, the mean arterial pressure (MAP) and central venous pressure (CVP) values were significantly decreased at T1, T2, T3 and T4 time points, the heart rates (HR) were significantly reduced at T1 time point in both groups, and the cardiac index (CI) was significantly increased at T2, T3 and T4 time points in CLCVP group and significantly increased at all T1, T2, T3 and T4 time points in GDFT group (all P<0.05). The MAP and HR showed no significant differences between the two groups at any time point (all P>0.05), but the CVP at T3 time point, CI at T2, T3 and T4 time points in GDFT group were significantly higher than those in CLCVP group (all P<0.05). Compared with the blood gas variables at T0 time point within group, the blood pH values were significantly decreased in both groups at T2, T3 and T4 time points (all P<0.05), the central venous oxygen saturation (SCVO2) showed no significant differences in CLCVP group at each time point (all P>0.05), but was significantly increased at T2, T3 and T4 points in GDFT group (all P<0.05), and the blood lactic acid (Lac) levels were significantly increased at all T1, T2, T3 and T4 time points in both group (all P<0.05). The pH values showed no significant differences between the two groups at any time point (all P>0.05), but the SCVO2 values were significantly higher at T2, T3 and T4 time points and the Lac levels were significantly lower at T3 and T4 time points in GDFT group than those in CLCVP group (all P<0.05). There were no statistically significant differences between the two groups in the amounts of crystal fluid, colloidal fluid and total fluid and urine volume (all P>0.05), but the intraoperative blood loss and time of hepatic blood flow occlusion were reduced in GDFT group compared with CLCVP group (both P<0.05).
Conclusion: In elderly patients undergoing open hepatectomy, using SVV-guided GDFT can stabilize the hemodynamic status, improve the blood gas indexes and reduce intraoperative hemorrhage and the time of liver blood flow occlusion.