The Observation Of Volume Management By Different Liquid Therapy In Infantile Liver Surgery

Objective:To discuss the effects on different fluid therapy in pediatric liver surgery by observing the arterial blood lactic acid value?Lac?,urine output,heart rate?HR?,Mean arterial pressure?MAP?and pulse pressure variation?PPV?.Methods:30 Children with liver surgery were enrolled in this study anddivided randomly into control group?group A?and the experimental group?group B?.Completed the epidural puncture and catheterization through the sacral canal to T11^T12 and inject 2ml of 1%lidocaine test dose,the internal jugular vein puncture catheterization guided by ultrasound and thearterial puncture catheterization guided by ultrasound 45minutes⁶0minutes after endotracheal intubation.Infants of The groupA infusioned the first hour requred fluid for Sodium Lactate Ringer's from entering the operating room to the begining of the operation:physiological requirements+1/2 accumulated loss:Physiological requirements+abstain preoperative fasting drink loss amount+10 ml·kg^-1·h^-11 surgical trauma is missing.Then infusioned corresponding Sodium Lactate Ringer's according to the laws of the 4-2-1 when the operation begined.Infants of The group B infusioned 10ml/kg hydroxyethyl starch for accumulated loss and infusioned physiological requirements+the rest accumulated loss for Sodium Lactate Ringer's from entering the operating room to the begining of the operation.When the operation begined,the infants infusioned Sodium Lactate Ringer's in the speed of the liquid of the second hour needed,adjusted the infusion speed according to PPV,maintained the PPV in under 13%and eliminated oppression vascular surgeons and spontaneous breathing PPV accuracy.All fluids using trace injection pump.Obvervational index:recorded the preoperative general condition of children,lactic acid value,blood gas analysis and hemoglobin in the begining?T₀?and ending?T₆?of the operation,mean arterial pressure?MAP?,heart rate?HR?and pulse pressure variation?PPV?in the begining of the operation?T₀?20 minutes after the start of operation?T₁?,the operation began after 40 minutes?T₂?,one hourafter The operation begined?T₃?,1 hour and 20 minutes after the start of operation?T₄?,1hour and 40 minutes after the start of operation?T₅?and theending of the operation?T₆?,he total infusion,infusion speed per hour,colloidalsupplement speed of the experimental group,time of operation,time ofanesthesia,urine output,post operative feeding time,post operative hospital time,Postoperative renal function and postoperative adverse reactions occurred.Results:1.There is no statistical differences in the heart rate and mean arterial pressure between the two groups at each time point.PPV of group A significantly greater than group B at T₂^T₆,p<0.05.In group A,T₂^T₆moment PPV is significantly higher than T₀ and T₁,p<0.05.2.Lactic acid value of group A was 1.93±0.52 mmol/l at the end of the operation,which in group B was 1.25±0.45 mmol/l,lactic acid of group B significantly less than group A,P<0.05.3.The total infusion of two groups are 19.54±2.84ml·kg^-1·h^-1,14.05±1.13 ml·kg^-1·h^-11 respectively,Group B significantly less than group A,P<0.05.4.Urine of group A was 1.93±0.52 ml·kg^-1·h^-1,which in group B was 2.12±0.84 ml·kg^-1·h^-1,urine of group B significantly more than group A,P<0.05.5.There is no significant difference between the two group of children in the preoperative general condition of children,lactic acid value,blood gas analysis and hemoglobin in the begining?T₀?and ending?T₆?,the total infusion,infusion speed per hour,colloidal supplement speed of the experimental group,time of operation,time of anesthesia,urine output,post operative feeding time,post operative hospital time.Conclusion:1.In pediatric liver surgery the PPV can predict the changes of capacity of infant patients.2.supplement the abstain fasting drink the amount of loss when using 10ml/kg hydroxyethyl starch,Can guarantee the stability of circulation.