Objective To investigate the effects of goal-directed fluid therapy (GDFT) based on pulse pressure variation (PPV) on postoperative cognitive function in patients undergoing Da Vinci robot-assisted radical resection of gynecological malignancies.

Methods A total of 60 patients who underwent robot-assisted radical resection of gynecological malignancies were randomly divided into control group and observation group using a random number table method, with 30 patients in each group. The control group received conventional fluid replacement regimen, while the observation group received GDFT regimen based on PPV. The surgical conditions, hemodynamic indices heart rate (HR), mean arterial pressure (MAP), PPV, cerebral oxygen saturation (rSO₂), gastrointestinal function, renal function, cognitive function Mini-Mental State Examination (MMSE) score, and postoperative conditions of the two groups were compared.

Results The amount of crystalloid fluid and urine output in the observation group were less than those in the control group, while the amount of colloid fluid was more than that in the control group, with statistically significant differences (P < 0.05).Five minutes after anesthesia induction, the levels of MAP, HR and rSO₂ in the observation group were higher than those in the control group, with statistically significant differences (P < 0.05). Five minutes after anesthesia induction, 1 hour after the Trendelenburg position, and immediately after the end of surgery, the PPV levels in the observation group were lower than those in the control group, with statistically significant differences (P < 0.05). After surgery, the levels of lactic acid and urea nitrogen in both groupswere higher than those before surgery, but those in the observation group were lower than those in the control group, with statistically significant differences (P < 0.05). After surgery, the creatinine levels in both groups were lower than those before surgery, but those in the observation group were higher than those in the control group, with statistically significant differences (P < 0.05). The time to first flatus in the observation group was earlier than that in the control group, with a statistically significant difference (P < 0.05). On days 3, 7 and 30 after surgery, the MMSE scores in the observation group were higher than those in the control group, with statistically significant differences (P < 0.05). The drainage tube indwelling time and hospital stay in the observation group were shorter than those in the control group, with statistically significant differences (P < 0.05). There was no statistically significant difference in the overall incidence of postoperative complications between the two groups (P>0.05).

Conclusion GDFT based on PPV can stabilize the hemodynamic status and rSO₂ in patients undergoing Da Vinci robot-assisted radical resection of gynecological malignancies and reduce postoperative cognitive impairment.