Comparison Of Restrictive Combined With Norepinephrine Versus Liberal Fluid Management During Laparoscopic Colorectal Surgery

Objectives:In laparoscopic colorectal surgery under general anesthesia,the combined use of noradrenaline and restricted infusion is used to maintain the average arterial pressure not less than 80% of the baseline value.The other group uses liberal infusion to maintain the same average arterial pressure target.So we compare two management schemes,whether limited infusion combined with noradrenaline can safely and effectively shorten the average of patients hospitalization days.Methods:This study is a prospective randomized controlled trial.104 patients were enrolled in this study.96 patients participated in the random and final statistical analysis.There were 48 patients in the restricted infusion group and 42 patients in the open infusion group.In the restricted infusion group,the mean arterial pressure was maintained by adjusting the dose of norepinephrine,so that the mean arterial pressure was not less than 80% of the baseline value;in the open infusion group,the mean arterial pressure was not less than 80% of the baseline value by accelerating infusion.The length of hospital stay was the main evaluation index of the two groups.The secondary evaluation index included the maintenance of circulation in the two groups,the comparison of liver and kidney function after operation,and the complications after operation.Results:The main evaluation index of this study was the days of hospitalization after operation.The days of hospitalization in restrictive infusion group were 7.6 ±0.7 days,which was significantly lower than that in open infusion group(8.5 ±0.8 days)(p=0.03);the baseline values of mean arterial pressure in restrictive infusion group and open infusion group were 89.6 ±3.6 mmHg and 88.2 ±3.8 mmHg,respectively.There was no significant difference between the two groups,but 10 minutes and 30 minutes after induction,at 60 minutes,at the end of surgery,the mean arterial pressure in the restrictive transfusion group was 81.5 ±4.3 mmHg,83.6 ±3.5 mmHg,83.3 ±3.2 mmHg,and 83.9 +3.1 mmHg at the four time points.The mean arterial pressure in the restrictive transfusion group was significantly higher than that in the open transfusion group at 79.2±3.1mmHg(p<0.01),79±2.3mmHg(p<0.001),77.5±2.1mmHg(p<0.001),81.7±2.9mmHg(p<0.01).There was no significant difference between the two groups in 230(100-300)ml and 200(100-350)ml,respectively.Due to the different methods of target management,the liquid intake in the restricted infusion group was 880(646-1164)ml,which was significantly lower than that in the open infusion group 1450(1237-1712)ml(p<0.01),and the cumulative use of norepinephrine in the restricted infusion group was 333.5(121-460)ug,respectively.The cumulative pumping time was 97 minutes(67.8-109.5)and the average pumping speed of norepinephrine was 3.2±1.8 ug/min.The cumulative time of intraoperative arterial pressure was less than 80% in both groups.The time of limited infusion group was 1.9±0.3 minutes,which was significantly lower than that of open infusion group(4.8±0.5 minutes)(p<0.001).There was no significant difference in the occurrence of complications between the two groups.Conclusions:Limited infusion with norepinephrine at the same time to maintain the mean arterial pressure can effectively shorten the hospital days after operation compared with open infusion to maintain the mean arterial pressure;does not increase the complications of liver,kidney and coagulation function;it can more effectively maintain the hemoglobin content and reduce the time of intraoperative hypotension.