The Effect Of Colloid Osmotic Pressure On Different Fluid Therapy Projects On Major Abdominal Surgery

Objective To evaluate the significance of colloid osmotic pressure for fluid therapy of perioperative patient, we observed the effect of colloid osmotic pressure on three different fluid therapy projects on major abdominal surgery, and the change of traditional fluid therapy index such as heart rate, blood pressure, central venous pressure, urine volume are also related.Method 90 patients who were undergoing selective operations were selected and divided into 3 groups, GroupⅠ(Group Crystalloid), GroupⅡ(Group Cystalloid-Colloid) and GroupⅢ(Group Home) by random, each group with 30 patients. Under operations, Lactated Ringer's solution were infused merely in GroupⅠ(Group Crystalloid), Lactated Ringer's solution and hydroxyethyl starch (Voluven) were infused with 1:1 in volume in GroupⅡ(Group Cystalloid-Colloid), each group was infused gross volume as CVE+physiological requirement+proceeding loss amount+thirdly loss amount. Hypertonic sodium chloride hydroxyethyl starch 40 (Home) and Lactated Ringer's solution were infused in GroupⅢ(Group Home),and the gross volume infused as Home recommendation add proceeding loss amount with thirdly loss amount. The alterations of colloid osmotic pressure, heart rate, blood pressure, central venous pressure, arterial blood gas analysis, gross infusion and urine volume in To(time point before fluid therapy), T1(time point on anesthesia induction), T2(time point on 1h after anesthesia induction), T3(right time point of operation's terminated), were observed.Result:1. Patients in three groups had no statistical diversity in age, gender, height, weight and ASA-PS(P＞0.05). 2. Patients in three groups had no statistical diversity in time during operation, dosage of anesthesia drugs, blood volume losed among surgery (P>0.05). 3. The total infusion volume in GroupⅢwas less than other two, remarkable, and it had statistical significance (P＜0.05), and urine volume in three groups had no statistical significance (P＞0.05).4. During anesthesia-operation, variation tendency of heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure was similar in all three groups. Compared time points in each groups, compared T0 with T1, T2, T3,it had statistical significance(P＜0.05), heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure in other time points was lower than T0, however, all of them were in normal range But compared time points among groups, it had no statistical significance at all (P＞0.05). In all three groups, there was no statistical significance in central venous pressure (CVP) compared time points with among or in groups(P＞0.05).5.In all three groups, there was no statistical significance in electrolyte compared time points with among or in groups(P＞0.05).6.Colloid osmotic pressure (COP) among all three groups during operations indicated as following. There was no statistical significance compared T0 with T1 and T2 (P＞0.05), and the situation was opposite with T3 (P＜0.05) in GroupⅠ, and COP was lower than T0. Compared T0 with T1, T2, T3, T4, there was no statistical significance in GroupⅡ. In GroupⅢ, compared T1 with T0, there was statistical significance (P＜0.05), and COP was higher than T0. It has no statistical significance compared T2, T3with T0. T4 (P＞0.05). In T0, there was no statistical significance(P＞0.05) with GroupⅠ, GroupⅡ, and GroupⅢ.However, in T1, the situations were opposite, compared GroupⅢwith GroupⅠandⅡ, there was statistical significance(P＜0.05). COP of GroupⅢwas the highest, and no statistical significance(P＞0.05) compared GroupⅠwith GroupⅡ. There was no statistical significance in T2 In T3, compared GroupⅠwith GroupⅡand GroupⅢ, there was statistical significance(P＜0.05), the COP of GroupⅠwas the lowest.Conclusions:1. All three fluid therapy projects can keep patients' hemodynamics stable.2. All three fluid therapy projects can not affect urine volume or electrolyte during surgeries obviously.3. Majorly infused Lactated Ringer's solution can lead colloid osmotic pressure down. Infused crystalloid:hydroxyethyl starch (Voluven) with 1:1 may maintain colloid osmotic pressure stablely during surgery. Minorly infused hypertonic sodium chloride hydroxyethyl starch 40 and crystalloid:hydroxyethyl starch (Voluven) with 1:1 can lead colloid osmotic pressure up temporary, and then they can maintain colloid osmotic pressure stablely during surgery.