【摘要】 目的:探讨目标导向液体治疗（GDFT）在腹腔镜肝脏手术中的应用及对术后认知功能的影响。方法:选取笔者所在医院拟行腹腔镜肝脏手术的80例患者为研究对象,采用随机数字表法将其分为常规组和GDFT组,各40例。比较两组不同时间点MAP、HR、CVP、CI、血乳酸（Lac）、尿素氮（BUN）水平。比较两组术中相关指标、手术前后MMSE评分及POCD发生情况。结果:两组不同时间点MAP、HR比较差异均无统计学意义（P>0.05）。T₂时,GDFT组CVP高于常规组,T₃时低于常规组,差异均有统计学意义（P<0.05）。T₂、T₃时,GDFT组CI高于常规组,差异均有统计学意义（P<0.05）。T₃、术后24 h,GDFT组Lac均明显低于常规组,差异有统计学意义（P<0.05）。两组不同时间点BUN比较差异均无统计学意义（P>0.05）。两组手术时间、出血量、尿量、晶体输液量、输液总量比较差异均无统计学意义（P>0.05）。GDFT组胶体输液量明显少于常规组,差异有统计学意义（P<0.05）。GDFT组术后1、3 d MMSE评分均明显高于常规组,差异有统计学意义（P<0.05）。两组POCD发生率比较差异无统计学意义（P>0.05）。结论:GDFT技术应用于腹腔镜肝脏手术,可维持血流动力学及重要脏器血流灌注的稳定,对脑组织有保护作用,有利于改善患者术后认知功能。更多还原

【Abstract】 Objective:To investigate the application of goal-directed fluid therapy （GDFT） in laparoscopic liver surgery and its effect on postoperative cognitive function.Method:A total of 80 patients who planned to undergo laparoscopic liver surgery in our hospital were selected as the research subjects,and the patients were divided into the routine group and the GDFT group,with 40 cases in each group by random number table method.MAP,HR,CVP,CI,blood lactate （Lac） and urea nitrogen （BUN） levels were compared between the two groups at different time points.Intraoperative related indicators,MMSE scores before and after surgery and the occurrence of POCD were compared between the two groups.Result:There were no significant differences in MAP and HR between the two groups at different time points （P>0.05）.The CVP of the GDFT group was higher than that of the routine group at T₂,and lower than that of the routine group at T₃,the differences were statistically significant （P<0.05）.The CI of the GDFT group were higher than those of the routine group at T₂ and T₃,the differences were statistically significant （P<0.05）.Lac of the GDFT group were significantly lower than those of the routine group at T₃ and 24 h after surgery,the differences were statistically significant （P<0.05）.There were no significant differences in BUN between the two groups at different time points （P>0.05）.There were no significant differences in operation time,blood loss,urine volume,crystal infusion volume and total infusion volume between the two groups （P>0.05）.The colloid infusion volume in the GDFT group was significantly lower than that in the routine group,and the difference was statistically significant （P<0.05）.The MMSE scores of the GDFT group were significantly higher than those of the routine group at 1 and 3 days after surgery,and the differences were statistically significant （P<0.05）.There was no significant difference in the incidence of POCD between the two groups （P>0.05）.Conclusion:The application of GDFT technology in laparoscopic liver surgery can maintain the stability of hemodynamics and blood perfusion in important organs,and has a protective effect on brain tissue,which is conducive to improving postoperative cognitive function of patients.更多还原