The Influence Of Different Intraoperative Fluid Strategies On The Colloid Osmotic Pressure Of Patients Undergoing Laparoscopic Gastrointestinal Operations

Objective 1. Compare the impact of different intraoperative fluid strategies, such as restrictive fluid administration or liberal fluid administration, and crystalloids or colloids on the COP of patients undergoing gastrointestinal operations.2. Evaluate whether COP can be a promising predictive parameter to guide intraoperative fluid management.Method 52 patients who were undergoing laparoscopic gastrointestinal surgery were divided into 4 groups randomly. Group R1 and Group R2 are received crystalloids and colloids in restrictive fluid regimen respectively, and Group L1 and Group R2 are received crystalloids and colloids in liberal fluid regimen respectively. General anesthesia was induced with intravenous drugs and maintained by continuous inhalation of sevoflurane and infusion of remifentanil. The ECG, heart rate, arterial blood pressure, SPO2, urine volume, PETCO2, the depth of anesthesia were measured continuously from entering the operation room. What’s more, the vasoactive agents, such as norepinephrine and atropine were used to maintain the blood pressure in a stable state. Record the result of arterial blood gas analysis and COP and all the above parameters at the time of beginning and 1h, 2h, 3h after infusion in the operation room respectively.Results 1. The COP of Group R1 and Group L1 decreased over time at any point in time(P<0.05). The COP of Group R2 was no different in compare with the baseline statistically(P<0.05). The COP of Group L2 was higher than the baseline after infusion for 1 hour but decreased after infusion for 3 hours(P<0.05). At any point in time, the COP of Group R2 and Group L2 was higher than the Group R1 and Group L1(P<0.05). And the COP of Group R2 and Group L1 were always lower than Group R2. The COP of Group L2 had been lower than Group R2 when infused for 3 hours.2. The increase of blood volume of L2 was higher than the other groups. The increase of blood volume of Group L1 was higher than Group R1. The increase of blood volume of Group L2 was higher than Group R1 after 2 hours’ infusion and was higher than both Group R1 and L1 after 3 hours’ infusion. The increase of blood volume of Group R1 went negative at all three testing time. What’s more, there were 2 cases of chemosis in Group L1 and L2 respectively.Conclusions 1. For the patients who were undergoing laparoscopic gastrointestinal surgery, the fluid infusion started with colloids can maintain plasma COP better.2. When patients were infused with a large volume of crystalloids rapidly can lower the COP and raise the risk of causing tissue oedema and postoperative complications.3. Measure the COP during intraoperative time may be helpful for fluid management and prevent the tissue oedema in a certain extent.