The Effects Of Intravenous Fluid Restriction On Hepato-nephro Function In Abdominal Operation Of Aged Patients

Objective To explore the effects of intravenous fluid restriction on hepato-nephro function in abdominal operation of aged patients and search a theory to support the intravenous fluid restriction.Method Sixty patients older than60years with an American Society of Anesthesiologists physical status of Ⅰ—Ⅲ who were undergoing elective operation on abdominal region. Patients were randomly assigned to receive a standard group (n=30) or a restricted group (n=30). In the standard group, fluid management according to Miller’s Anaesthesia’s opinion:Rate of fluid administration=CVE+Deficit+Maintenance+Loss+Third space. In the restricted group, patients were administered half of deficit before the opration, then the initial infusion rate is4ml/kg/h, the CVP was measured every15minutes and maintained it at5-7cmH20, without limiting the total amount of transfusion. In both groups crystals and colloid’s ratio is2:1, the crystal choosed to use the lactated Ringer’s solution, and the colloid choose the HS130/0.4(Voluven). ECG, BP, SpO2, CVP and liquid intake and output volume were monitored in the whole process of anaesthesia. In both groups, the venous blood sample were taken before anaesthesia (T1) and in the24hours after the operation (T2) for determination of hepato-nephro function (ALT,AST and BUN,Cr).The postoperative neopathy, recovery of digestive tract function and length of stay were traced after the patients returned to the ward. All the data were analysed by the SPSS13.0.Results The liquid intake volumes administered in the restricted group was significantly lower than the standard group (P<0.05); The restricted group’s CVP was significantly lower than the standard group (P<0.05), but still within the normal range; The postop-AST of the restricted group was higher than the preop-AST(P<0.05), and also within the normal range; Compared with the preop-ALT, preop-BUN, preop-Cr, the posto-ALT, posto-BUN and posto-Cr of the restricted group have no significant differences (P>0.05); Compared with the standard group,the postop-AST, posto-ALT, posto-BUN and posto-Cr of the restricted group have no significant differences (.P>0.05); The quantity of patients with postoperative neopathy in restricted group was lower than the standard group’s (P<0.05). Patients in restricted group passed flatus and feces were significantly earlier(P<0.05), and their length of stay was significantly shorter(P<0.05).Conclusion The use of restrictive fluid management during elderly patients undergoing operation on abdominal region is safe, feasible and advantageous. Because this strategy can be able to maintain stable hemoperfusion to the liver and kidney, reduce postoperative neopathy, and shorten their length of stay.