| Objective:The fluid therapy during operation is a neglected part in the clinical anesthesia, but it is indispensable and crucial for the patient vital signs and homeostasis. However, the appropriate solutions for the fluid therapy during operation still don’t have an exact conclusion, especially for the Spine Surgery. The credible related research and data are still lack. This research is based on all of these, carried out the zero-balanced fluid protocols for the patients undergoing spine surgery to apply different kinds of fluids, and evaluate the indicators during and after surgery. To explore the suitability of the zero-balanced fluid regime in spine surgery, and according to the comparison, choose the rational fluid therapy, and also provide reference and foundation for clinical anesthesia of spine surgery.Methods:Patients were chosen from Yan’an University Affiliated Hospital, who would schedule for spine surgery, ASA I-II, from Dec 2014 to July 2015. And separated them into 3groups randomly: Crystalloids Group(A), Colloids Group(B) and Crystal-Colloids Group(C). Respectively gave the Sodium Lactate Ringer’s Injection, Hydroxyethyl Starch 200/0.5 and Sodium Chloride Injection and two liquids proportion 1:1. Every intravenous speed of fluids is the same. Blood loss during operation supply by proportion3:1 of Sodium Lactate Ringer’s Injection in Group A; 1:1 of Hydroxyethyl Starch 200/0.5and Sodium Chloride Injection in Group B; Half by 3:1 of Sodium Lactate Ringer’s Injection, the other half by 1:1 of Hydroxyethyl Starch 200/0.5 and Sodium Chloride Injection in Group C. Record patients’ baseline information. Observe the change of ECG and at the time of before anesthesia(T0), immediate after intubation(T1), before skinincision(T2), after skin incision 60 min(T3), after skin incision 120 min(T4) and before the surgery finish(T5). Individually record SBP, DBP, MAP, HR, SPO2 and PET-CO2,and at T2 and T5, survey blood routine, liver and kidney function, serum electrolytes,blood coagulation. Draw arterial blood to do the blood gas analysis. Record the surgery time, infusion time, volume of the total in and out, volume of blood transfusion and doses of anesthetic during operation. Observe the postoperative morbidity and mortality, the rate of nausea and vomiting, the time of exsufflation and defecating after operation and length of stay in hospital. Primary outcomes are: postoperative morbidity and mortality,and the special situation during surgery. Secondary outcomes are the haemodynamics,oxygenation indexes, laboratory indexes, volume of the total in and out, doses of anesthetic during operation, the recovery time of gastrointestinal function, and the length of stay in hospital.Outcomes:1. Patients with Level I complications: the number of Group A is more than Group B,the difference was statistically significant(8 vs. 1, P=0.038); But the difference between Group B and C doesn’t have statistical significance. And in the total complications, the number of Group A is obviously more than Group B, the difference was clear statistically significant(11 vs. 1, P=0.005); In the occurrence number, Group A is more than Group C,the difference also was statistically significant(11 vs. 2, P=0.012); The difference between Group B and Group C doesn’t have statistical significance either.2. In the number of applying the aramine for 3 groups patients, Group A is obviously more than Group B, the difference was statistically significant(22 vs. 2, P=0.006); Group A is more than Group C, the difference doesn’t have statistical significance; And Group B is less than Group C, the difference doesn’t have statistical significance either. In the number of special situation during operation, Group A is obviously more than Group B,the difference also was clear statistically significant(25 vs. 5, P=0.008); Group A is more than Group C, the difference doesn’t have statistical significance(25 vs. 15); And Group B is less than Group C, the difference doesn’t have statistical significance either(5 vs.15).3. The SBP during operation, in Group A, T4 is higher than T2, the difference has statistical significance(115.63±17.73 mm Hg vs. 106.00±19.45 mm Hg, P=0.010), T5 is obviously higher than T2, the difference has statistical significance(115.30±19.30 mm Hg vs. 106.00±19.45 mm Hg, P=0.008); In Group C, T5 is obviously higher than T2, the difference has statistical significance(119.80±13.41 mm Hg vs. 105.60±11.60 mm Hg,P=0.006).The DBP, In Group A, T4 is higher than T2, the difference has statistical significance(62.25±9.65 mm Hg vs. 55.80±14.60 mm Hg, P=0.021), T5 is higher than T2, the difference has statistical significance(63.70±9.94 mm Hg vs. 55.80±14.60 mm Hg,P=0.025); In Group C, T5 is higher than T2, the difference has statistical significance(63.80±9.93 mm Hg vs. 56.00±7.94 mm Hg, P=0.011).The MAP, In Group A, T4 is obviously higher than T2, the difference has clear statistical significance(79.13±10.92 mm Hg vs. 71.10±15.28 mm Hg, P=0.004), T5 is higher than T2, the difference has statistical significance(78.90±12.47 mm Hg vs.71.10±15.28 mm Hg, P=0.013); In Group C, T4 is higher than T2, the difference has statistical significance(75.44±9.18 mm Hg vs. 70.20±10.05 mm Hg, P=0.045), T5 is obviously higher than T2, the difference has clear statistical significance(81.00±11.06 mm Hg vs. 70.20±10.05 mm Hg, P=0.002).In the coagulation function of Group A, in the PT, T5 is obviously higher than T2, the difference has statistical significance(13.71±0.89 sec vs. 12.79±0.52 sec, P=0.006), in the INR, T5 is higher than T2, the difference has statistical significance(1.09±0.08 vs.1.04±0.07, P=0.021). In the FDP, T5 is higher than T2, the difference has statistical significance(10.31±9.95 ug/ml vs. 5.26±6.41 ug/ml, P=0.026). In the DD, T5 is higher than T2, the difference has statistical significance(2.75±2.22 ug/ml vs. 1.41±1.66 ug/ml,P=0.016); In PT of Group B, T5 is higher than T2, the difference has statistical significance(14.72±1.13 sec vs. 13.30±0.89 sec, P=0.011). In the APTT, T5 is higher than T2, the difference has statistical significance(44.20±10.89 sec vs. 35.26±11.63 sec,P=0.019); In PT of Group C, T5 is higher than T2, the difference has statistical significance(14.17±1.11 sec vs. 13.15±0.66 sec, P=0.003). In the INR, T5 is higher than T2, the difference has statistical significance(1.13±0.08 vs. 1.08±0.05, P=0.019). In the FDP, T5 is higher than T2, the difference has statistical significance(8.16±5.87 ug/ml vs.3.63±1.97 ug/ml, P=0.019). In the DD, T5 is higher than T2, the difference has statistical significance(2.09±1.60 ug/ml vs. 1.07±0.71 ug/ml, P=0.043).4. The volume of fluid intravenous in three groups, Group A is more than Group C,and Group C is more than Group B, the numbers are 2651.40±802.68 ml, 2326.80±745.29 ml and 1875.40±686.79 ml, the difference doesn’t have statistical significance(P=0.083).The blood lose during operation, Group A is more than Group B, Group B is more than Group C, the numbers are 341.00±140.75 ml, 333.00±154.92 ml and 302.00±280.98 ml,the difference also doesn’t have statistical significance(P=0.902).The urine output during operation, Group A is more than Group B and Group C, the numbers are 505.00±321.84 ml, 440.00±397.77 ml and 420.00±339.28 ml, the difference doesn’t have statistical significance too(P=0.855).5. The time of exsufflation after operation, Group B is earlier than Group A, Group A is earlier than Group C, the numbers are 2.60±0.97 d, 2.70±1.16 d and 3.00±1.63 d, the difference doesn’t have statistical significance(P=0.771).The time of defecation after operation, Group B is earlier than Group C, Group C is earlier than Group A, the numbers are 3.50±1.08 d, 4.00±1.63 d and 4.60±4.27 d, the difference also doesn’t have statistical significance(P=0.667).6. The total length of stay in hospital: Group A is shorter than Group C, Group C is shorter than Group B, the numbers are 18(17; 95% CI; 25) d, 19(15; 95% CI; 30) d and28(17; 95% CI; 35) d, the difference doesn’t have statistical significance(P=0.445).The length of stay after surgery: Group A is earlier than Group B, Group B and Group C are the same. The numbers are 13(12; 95% CI; 19) d, 14(12; 95% CI; 29) d and 14(12; 95% CI; 17) d, the difference also doesn’t have statisticalsignificance( P=0.687).Conclusions:1. Zero-balanced fluid regime makes patients in spine surgery have hemodynamics stable, less adverse reactions and has favourable prognosis, it’s suitable for spine surgery.2. To adopt crystal-colloids mixture to proceed the zero-balanced fluid regime has a small influence for patients in spine surgery, it has higher safety and the result is satisfied.It can decrease the postoperative complications and becomes more suitable in the fluid therapy of spine surgery. |
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