关键词: 肝细胞癌, 肝部分切除术, 目标导向性液体治疗, 晶体液, 胶体液, 麻醉

Abstract: Objective The aim of this study was to investigate the influence of crystal and colloidal liquid infusion base on goal-directed fluid therapy (GDFT) during anesthesia on clinical efficacy and safety in patients with hepatocellular carcinoma (HCC) undergoing partial hepatectomy. Methods 90 patients with HCC were enrolled in our hospital between October 2017 and October 2018, and all patients underwent partial hepatectomy. The patients were randomly divided into 3 groups including control (n=30) with conventional liquid management, colloidal group (n=30) with fast filling of colloid liquids and crystal group (n=30) with fast filling of crystal liquids during anesthesia. The central venous oxygen saturation (ScvO₂), as well as blood lactate (Lac) and glucose (Glu) levels were monitored. Results The time of first exhaust, time of early ambulation, and hospitalization stay after operation in colloidal group were (55.8±8.3)h, (3.4±0.5)d and(7.8±1.5)d, in crystal liquid group were (54.7±8.0)h, (3.6±0.7)d and (8.1±1.7)d, all significantly shorter than (62.3±10.1)h, (4.6±0.9)d and (10.2±2.6)d(P <0.05) in the control; at T3 and T4, the ScvO₂ in colloidal group was (83.7±7.1)% and (84.2±7.5)%, in crystal liquid group was (82.1±7.8)% and (82.5±8.0)%, all superior to (76.4±6.7)% and (74.9±5.4)%(P <0.05), respectively, in the control, at T2, T3 and T4, blood Lac levels in the colloidal group were (1.3±0.3)mmol/L, (1.7±0.4)mmol/L and (1.8±0.4)mmol/L, in crystal liquid group were (1.4±0.2)mmol/L,(1.8±0.4)mmol/L and (1.9±0.5)mmol/L, all much lower than (1.7±0.3)mmol/L,(2.2±0.5)mmol/L and (2.6±0.7)mmol/L(P <0.05), respectively, in the control, and blood Glu levels in the colloidal fluid group were (5.5±0.8)mmol/L, (7.0±1.3)mmol/L and (6.8±1.1)mmol/L, in crystal fluid group were (5.6±0.7)mmol/L, (7.1±1.0)mmol/L and (7.2±1.2)mmol/L, all superior to (6.3±1.1)mmol/L,(8.4±1.7)mmol/L and (8.2±1.4)mmol/L(P <0.05), respectively, in the control; on day five of post-operation, serum ALT levels in colloidal and crystal liquid groups were (65.3±7.6)U/L and (68.3±7.4)U/L, both significantly lower than (123.4±15.3)U/L(P <0.05) in the control; the incidence of nausea and vomiting after operation in colloidal group was6.7%, significantly lower than 33.3% and 26.7%(P<0.05) in other two groups. Conclusion Compared with conventional liquid management, the application of crystal and colloidal liquid infusion under the guidance of goal-directed fluid therapy in patients with HCC undergoing partial hepatectomy could efficiently accelerate the recovery of health after operation, which might be related to the increase of tissue perfusion and liver function protection. Fast filling of colloidal liquids might reduce the risk incidence of nausea and vomiting after operation.

Key words: Hepatoma, Partial hepatectomy, Crystal fluid, Colloidal fluid, Goal-directed fluid therapy, Anesthesia