A Comparative Clinical Study Of Crystalloid And Colloid Goal-directed Fluid Therapy In Robotic Abdominal Surgery

ObjiectiveFluid volume and type both all can affect the prognosis of patients.Goal-directed fluid therapy(GDFT)can improve the volume state of patients by optimizing the hemodynamic parameters and individualized fluid therapy,so as to reduce a series of postoperative complications caused by fluid imbalance.Studies have confirmed that perioperative application of GDFT can reduce postoperative complications in patients undergoing abdominal surgery compared with standard fluid therapy.However,there is no final conclusion on the choice of crystalloid and colloid.In addition,the robotic surgery takes a long time and requires pneumoperitoneum and Trendelenburg position during abdominal surgery,which requires higher requirements for intraoperative fluid management and hemodynamic stability.In this study,the use of GDFT in robotic abdominal surgery and postoperative morbidity survey(POMS)score were used to compare the effects of crystalloid and colloid on the incidence of postoperative complications.MethotsThis trial is a prospective,randomized controlled study.We selected 60 patients who underwent elective Da Vinci robot-assisted abdominal surgery in the Eastern District of the first affiliated Hospital of Zhengzhou University from June 2019 to October 2019.All patients were randomly assigned to goal-directed crystalloid group(LR)or goal-directed colloid group(HES),all patients maintained infusion of 0.9%saline 4 ml/kg/h during the operation.If CI≥2.5L/min/m2,MAP<70mmHg,intravenous pump noradrenaline 0.01-0.08μg/kg/min to maintain MAP above 70mmHg.After the MAP reaches the target value,the hemodynamic parameters of the patients were re-evaluated;if CI≥2.5L/min/m2,MAP≥70mmHg,and SVV>13%for more than 2 minutes,the LR group was infused with 200ml of Ringer’s solution within 10 minutes or HES group infused with hydroxyethyl starch(130/0.4)200ml within 10 minutes,re-evaluating SVV after 5 minutes,if SVV is still greater than 13%,repeated the above operation;if CI<2.5L/min/m2,SVV>13%then continue to perform fluid bolus therapy(same as above);if CI<2.5L/min/m2,SVV≤13%,intravenous injection of ephedrine 3 to 6 mg/time,maintaining CI≥2.5L/min/m2.Postoperative primary outcome measure was postoperative morbidity survey(POMS).Secondary outcome measures were the time of first exhaust or defecation、length of hospital stay(LOS)、Intensive Care Unit(ICU)stay、incidence of acute kidney injury(AKI)and mortality within 30 days after surgery.Statistical analysis was performed using IBM SPSS Statistics 24.0 software.Comparative analysis using t test、paired t test、χ2 test or repeated measures analysis of variance.ResultsOur trial eventually included 60 patients,30 cases in each group.There was no difference in general statistical data between the two groups of patients.Compared with HES group and LR group,the number of fluid bolus(3.7± 1.7 vs 4.9±2.0,P=0.020)and ephedrine dosage(3.9±6.3 vs 7.4±6.6,P=0.041)were statistically significant.Norepinephrine was not used in both groups.The incidence of postoperative complications、time of first exhaust or defecation(2.3±1.3 vs 1.8±0.9,P=0.128)and length of hospital stay(8.41 ±3.2 vs 9.1 ±2.9,P=0.393)between HES group and LR group were no significant difference.There were no patients with acute kidney injury、ICU treatment or death within 30 days after operation in both groups.ConclusionsWhen GDFT was used in patients undergoing robotic abdominal surgery,the incidence of postoperative complications is similar between crystalloid and colloid.In the colloid group,the number of intraoperative fluid bolus and the amount of vasoactive drugs were less.