The Effect Of Different Liquid Treatment Strategies On The Internal Environment Of Breast Cancer Surgery Patients

Objective: In this study, we observed the effect of several liquidtreatment strategies on the intraoperative interval environment of breastcancer patients undergoing elective operation. Thereby providing clinicalevidence for reasonable infusion in such elective, short and non-gastrointestinal surgery.Methods: Selected60ASA grade I-II level breast cancer patients,who got elective modified radical mastectomy, aged30-60years old.Those breast cancer patients were randomly divided into four groups: A,B, C and D group. The day before surgery, all patients accepted thegastro-intestinal tract preparation by routine. After entering the operatingroom, all patients were connected the multi-function monitor to monitorheart rate (HR), electrocardiogram (ECG), mean arterial pressure (MAP),oxygen saturation (SpO₂), central venous pressure (CVP) and otherindicators. All patients had TCI total intravenous general anesthesia. Theeach group was uniform input of Ringer's lactate at the speed of10ml/kg·h after the vein open, anesthesia induction after30minutes.After the anesthesia induction, A group was transfused Ringer's lactate atthe speed of20ml/kg·h for30minutes, B, C and D groups weretransfused Voluven at the speed of20ml/kg·h for30minutes. Theoperation began after30min. At the beginning of operation, A and Bgroups were inputted compound sodium chloride injection.C and Dgroups were replaced with invert sugar and electrolytes injection andcompound sodium lactate and sorbitol injection respectively, and thespeed was all10ml/kg·h, the infusion time was1hour. After1hour, A, B,C and D group were all transfused with compound sodium chloride injection at the speed of10ml/kg·h until the end of operation. The heartrate (HR), electrocardiogram (ECG), mean arterial pressure (MAP),central venous pressure (CVP), and oxygen saturation (SpO₂) wererecorded respectively at the time of immediately before anesthesiainduction (T₁), immediately before surgery start (T₂),30minutes aftersurgery start (T₃),60minutes after surgery start (T₄) and90minutes aftersurgery start (T₅). At each time point, collecting arterial blood2mlimmediately for arterial blood gas analysis (PH, SB, BE, PaCO2, HCT,HB). Collecting venous blood for coagulation function (PT and APTT),electrolytes (Na+, K+, Cl, Ca²⁺, Mg²⁺), and blood glucose (GLU).Results:1Hemodynamic changes: MAP, CVP and HR of each groupspatients at the T₁time point were all no statistically different (P＞0.05).MAP of B, C, D gorup patients comparison within the group at T₂-T₅time point were no statistically different (P＞0.05). MAP of A grouppatients at the T₂-T₅time point were all less than the basic value (P<0.05).Comparison with the B, C and D group, A group MAP at T₂-T₅time pointwere significantly lower (P<0.05). HR of four groups patients were alldecreased at T₂time point (P<0.05), and at each time point comparisonwithin group showed no significant difference (P>0.05). CVP of A grouppatients were lower than B, C and D group at T₂-T₃time point(P<0.05); Comparison within group and among groups of B, C and Dgroup at each time point showed no significant difference (P>0.05).2HCT changes: Comparison within group: HCT of each grouppatients at T₂time point were decreased (P<0.05), and it had significantdifference compared with T₁time point. A group patients in the T₃-T₅gradually returned to pre-anesthetic level (P>0.05); B, C and D groupmaintained a low level (P<0.05) Comparison among groups: Comparisonamong groups of each group at T₁and T₂showed no significantdifference (P>0.05). HCT of A group patients at T₃-T₅were all higherthan those of B, C and D group (P<0.05). Comparison among groups of B, C and D group at each time point were no significant difference (P>0.05).3Coagulation function changes: Comparison within group: PT andAPTT of A group patients at each time point showed no significantdifference (P>0.05); PT and APTT of B, C, D group at T₂-T₅were moreprotensive than those of T₁time point (P<0.05). Comparison amonggroups: Comparison among groups of four groups patients PT and APTTat T₁time point showed no significant difference (P>0.05). PT and APTTof B, C, D group at T₂-T₅were more protensive than those of A group(P<0.05). Comparison among groups of B, C, D group PT and APTT atT₂-T₅were all no significant difference (P>0.05).4Electrolytes and blood glucose changes: Basic value of four groupspatients electrolytes and blood glucose showed no significant difference(P>0.05). Serum Na+of C group patients at T₃-T₅time point were alllower than basic value (P<0.05); comparison among groups showedlower than A, B, D group (P<0.05). Comparison within group and amonggroups of A, B, D group patients serum Na+at each time point showed nosignificant difference (P>0.05). Serum K+of B, D group at T₂-T₅timepoint were all lower than basic value (P<0.05); C group showed lower atT₂time point (P<0.05) and then rose to the basic level (P>0.05); A groupat each time point showed no change (P>0.05). Serum K+of B, C, Dgroup at T₂were all lower than A group (P<0.05); B, D group at T₃-T₅showed lower than A, C group (P<0.05). Serum Cl of A group patients atT₃-T₅time point were all higher than basic value (P<0.05); B, D group atT₂-T₅showed higher than basic value (P<0.05); C group at T₂rose(P<0.05) and then fell back at T₃-T₅(P>0.05). Serum Cl of B, C, Dgroup at T₂showed higher than those of A group (P<0.05); C group atT₃-T₅showed lower than A, B, D group (P<0.05). Serum Ca²⁺of B, C, Dgroup at T₂-T₅were all lower than basic value (P<0.05); comparisonwithin group of A group showed no significant change (P>0.05). SerumCa²⁺of A group at T₂-T₅were all higher than those of B, C, D group (P<0.05); comparison among groups of B, C, D group showed nosignificant difference (P>0.05). Serum Mg²⁺of B, C,D group at T₂wereall lower than basic value (P<0.05); C group at T₃rose to the basic level(P>0.05), at T₄-T₅higher than basic value (P<0.05). Serum Mg²⁺of Agroup at each time point showed no change (P>0.05); B, C, D group at T₂were all lower than A group (P<0.05); B, D group at T₃-T₅were all lowerthan A, C group (P<0.05); no significant difference was found in thecomparison between B group and D group (P>0.05). No significantdifference was found in the comparison between B group and D groupserum Mg²⁺at T₃time point (P>0.05); C group serum Mg²⁺showedhigher than those of A group at T₄-T₅(P<0.05). GLU of C group patientsat T₃-T₅were all higher than basic value (P<0.05); comparison withingroup of A, B, D group showed no statistical difference (P>0.05); Cgroup patients GLU at T₃-T₅showed higher than those of A, B, Dgroup(P<0.05); comparison among groups of A, B, D group showed onstatistical difference (P>0.05).5Changes in acid-base balance: Comparison among groups of eachgroup PH,SB,BE at T₁showed no statistical difference (P>0.05).Comparison within group: Plasma PH of A group patients at T₄-T₅wereall lower than basic value (P<0.05). Plasma PH of B, C, D group at T₂-T₅were all lower than basic value (P<0.05); Plasma PH of B, C, D group atT₂-T₃showed lower than those of A group (P<0.05). Plasma PH of Bgroup at T₄showed lower than those of A group (P<0.05); comparisonamong groups of A, C, D group showed no statistical difference (P>0.05).Comparison among groups of four groups plasma PH at T₅showed nostatistical difference (P>0.05). Comparison among groups of four groupsplasma SB at T₁showed no statistical difference (P>0.05). Plasma SB ofA group at T₂-T₅were all higher than those of the other three groups(P<0.05). Whole blood BE of A group at T₂-T₄were all higher than theother three groups (P<0.05). Comparison among groups of four groupswhole blood BE at T₁and T₅showed no statistical difference (P>0.05). Conclusions:1After anesthesia induction, the infusion of voluven at the speed of20ml/kg·h for30minutes, the hemodynamics during anesthesia periodshow more stable compared with the same amount infusion of Ringer'slactate at the same speed.2After anesthesia induction, the infusion of voluven at the speed of20ml/kg·h for30minutes can lead to mild hemodilution and diluted K+,Mg²⁺and Ca²⁺to reduce.3In operation, the infusion of invert sugar and electrolytes injectionat the speed of10ml/kg·h for1hour can supplement the lack of K+andMg²⁺, but at the same time can lead to elevated blood glucose; the sameamount infusion of compound sodium lactate and sorbitol injection at thesame speed can relieve the lack of K+and Ca²⁺, but not sufficientcomplement.4Intraoperative infusion of Voluven, the compound sodium chloridecan cause mild of Na⁺, Cl increased. PH, BE and SB decreased slightly.