Effect Of Target-Directed Fluid Therapy Combined With α2-AR Agonist On Tourniquet Response In Patients Undergoing Finger Replantation

Objective To investigate the effect of target directed fluid therapy combined with highly selectiveα₂-adrenergic receptor（α₂-AR）on replantation of severed fingers.Methods four different methods were used in replantation of severed fingers,including routine fluid replacement,target directed fluid therapy,dexmedetomidine and target directed fluid therapy combined with dexmedetomidine Effects of agonists on upper limb ischemia-reperfusion injury induced by tourniquet in patients undergoing replantation of severed fingers.Methods From 2018 to 2019,100 patients aged 18-60 years,ASA I-II,with injury time less than 6 hours were selected from the Department of hand surgery of Renhe Hospital Affiliated to Three Gorges University.The patients had no severe systemic disease,coagulation dysfunction,local anesthetic hypersensitivity before operation,and were approved by the ethics committee of our hospital and signed the informed consent form by the patients（202006）and their families Acoustic guided"interscalene"brachial plexus block.The patients were randomly divided into four groups:routine rehydration group（Group C）,goal-directed fluid therapy group（group G）,dexmedetomidine group（Group D）,goal-directed fluid therapy combined with dexmedetomidine group（group G+D）,with 25cases in each group.Blood pressure（BP）,stroke volume（SV）,heart rate（HR）and cardiac output（CO）were continuously monitored by LIFEGARD ICG noninvasive impedance hemodynamics system.3-4m L radial artery blood was collected at each time point 5 min before the upper tourniquet（T₀）,immediately after tourniquet loosening（T₁）and 2h after tourniquet loosening（T₂）.The levels of interleukin-1β（IL-1β）,interleukin-6（IL-6）,transforming growth factor（TGF-β1）,malondialdehyde（MDA）and superoxide dismutase（SOD）were detected.The differences of intraoperative rehydration volume,inflammatory factors and oxidation products in the four groups were compared and analyzed.Results（1）There were no significant differences in sex ratio,age,height,weight,preoperative fasting time and operation time among the four groups（P>0.05）.（2）Perioperative fluid infusion volume:compared with group C,intraoperative fluid infusion volume of group G and group G+D was significantly reduced,while colloidal fluid infusion volume was significantly increased（P<0.05）.There was no significant difference in intraoperative lens colloid infusion volume in group D（P>0.05）;Compared with group G,intraoperative lens colloid infusion volume in group D increased significantly,while intraoperative colloid infusion volume decreased significantly（P<0.05）;There was nosignificant difference in intraoperative lens colloid infusion volume in group G+D（P>0.05）;compared with group D,intraoperative lens colloid infusion volume in group G+D decreased significantly,but intraoperative colloid infusion volume increased significantly（P<0.05）;There was no significant difference in the dosage of dexmedetomidine during operation（P>0.05）.（3）Inflammatory factors:compared with T₀,T₁and T₂of the four groups were significantly higher Compared with group C,the concentrations of IL-1β,IL-6,IL-10 and TGF-β1 in group D,G and G+D increased slowly from T₀to T₁,and decreased rapidly from T₁to T₂（P<0.05）.There was significant difference in perioperative fluid volume between group D and G,G+D（P<0.05）.Compared with group G,the concentrations of IL-1β,IL-6 and TGF-β1 in group D and G+D increased slowly from T₀to T₁Compared with group D,the concentrations of IL-1β,IL-6 and TGF-β1 in group G+D increased slowly from T₀to T₁and decreased rapidly from T₁to T₂(（P<0.05）.（4）Oxidation emergency products:compared with T₀,four groups of experiments T₁,T₂Compared with group C,the concentration of MDA in group D,G and G+D increased slowly from T₀to T₁,decreased rapidly from T₁to T₂（P<0.05）,and SOD decreased on the contrary（P<0.05）;compared with group G,the concentration of MDA in group D and G+D increased slowly from T₀to T₁,decreased rapidly from T₁to T₂（P<0.05）,and SOD decreased on the contrary（P<0.05）;Compared with group D,the increase rate of MDA concentration in group G+D was slower from T₀to T₁,and the decrease rate was faster from T₁to T₂（P<0.05）.Conclusion Dexmedetomidine can effectively reduce tourniquet induced upper limb ischemia-reperfusion injury in patients undergoing finger replantation;Target oriented liquid therapy combined with dexmedetomidine is more effective than other liquid therapy in finger replantation.