| Background Patients with colorectal cancer,due to chronic diarrhea,intestinal obstruction,tumor bleeding and preoperative fasting,bowel preparation,are in a state of dehydration,anemia and hypoalbuminemia,thus increasing the indicdence of postoperative complications.A good perioperative fluid therapy may ensure the effective circulating blood volume,the adequate blood perfusion and oxygen supply of organs and tissues,ensure the stability of the internal and external environment of tissue cells and acid-base balance,and greatly reduce the postoperative complications of patients.The clinical observation of the patients with different fluid therapy shows that the application of the restricted fluid therapy strategy in abdominal surgery can promote the recovery of intestinal function,reduce the incidence of incision infection,cardiopulmonary complications,and shorten the length of hospitalization and reduce the mortality rate of patients.However,during anesthesia,the use of single crystal fluid for restricted fluid replacement is likely to induce severe hemodynamic fluctuations during the process of anesthesia induction and special operation,which greatly increases the use of various vasoactive drugs.Moreover,the excessive restriction of fluid replacement during perioperative period may increase the incidence of acute renal injury.The application of hydroxyethyl starch may increase the osmotic pressure of vascular colloid and maintain the stability of blood volume.In order to further ensure the safety of colorectal surgery and reduce the occurrence of various complications from anesthesia and surgery,crystalloid-colloid restricted fluid therapy were used to replenish the fluid during the operation,and we observed the effect of this method on the intraoperative physiological and biochemical indexes of patients and various postoperative complications.Objective To explore the effect of various restricted fluid therapies on hemodynamics,acid-base balance,electrolyte,intestinal edema,postoperative rehabilitation,complication rate,liver and kidney function during laparoscopic radical resection of colorectal cancer.Method 90 patients with colorectal cancer from the second affiliated hospital of dalian medical university were randomly divided into three groups:conventional fluid group?Group C?,crystal restrictied fluid group?Group R?and crystalloid-colloid restricted fluid group?Group H?.The patients were fasted for 6 hours and water was withheld for2 hours before operation.Routine intestinal preparation was performed,and the lost fluid was replenished under the guidance of the surgeon in the ward.After entering the room,ECG,finger pulse oxygen,invasive radial artery pressure,bispectral index?BIS?were monitored,and thermal insulation blanket was used.The same anesthesia induction and maintenance program were used in all three groups.The anesthesia depth was adjusted by anesthesiologist based on BIS value,keeping its value between 40 and60.Postoperative recovery was performed in PACU.The heart rate,mean arterial pressure,body temperature,BIS value,arterial blood gas analysis results,urinary specific gravity of the three groups at the period of T0?when patient entered the room?,T1?immediately after the operation started?,T2?intraoperative 1h?,T3?intraoperative2h?,T4?the end of the surgery?were recorded;the intraoperative fluid volume,use of vasoactive drugs,intraoperative pathological samples of intestinal tissue,preoperative and postoperative changes of liver and kidney function,postoperative defecation and drainage,the time of extubation,postoperative nausea and vomiting,anastomotic leakage and intestinal obstruction rate were recorded.Before anesthesia induction,all patients in the three groups were given 6 ml·kg-10.9%normal saline?NS?and 100ml antibiotic prophylactically.After anesthesia induction,group C was supplemented with the amount of accumulated loss,intraoperative physiological requirement and the loss of third gap loss in accordance with the routine rehydration plan,with the upper limit not exceeding 30ml·kg-1·h-1;Group R was infused with 0.9%normal saline at the rate of 4ml·kg-1·h-1until the end of the operation.Group H was infused with continuous infusion of NS at the rate of 2ml·kg-1·h-1and 6%HES 130/0.4?Voluven?continuous pump injection at the rate of 2 ml·kg-1·h-1until the end of the operation.The intraoperative average arterial pressure?MAP?was kept above 65mmhg.If MAP was lower than the target value,all three groups were given 100ml of 0.9%normal saline rapidly?as a remedial fluid?.If MAP was still lower than the target value,the patients would be given intravenous pumps of norepinephrine.After the blood pressure was stable,the original velocity liquid input was maintained.If MAP was lower than the target value again,the above procedures would be repeated.For patients with hypertension,the control of preoperative MAP should not be less than 20%of the basic value.The intraoperative blood loss of the three groups was supplemented with voluven1:1.Results The total fluid intake in group C was significantly higher than that in Group R and group H?P<0.05?.Compared with Group R,the occurrence rate and volume of remedial fluid in group H decreased?P<0.05?.The utilization rate of vasoactive drugs in Group R was significantly higher than that in group C?P<0.05?.The utilization rate in group H was lower than that in Group R,but the difference was not statistically significant.The mean arterial pressure of H group at T1 and T2 was significantly higher than that of R group?P<0.05?,and the fluctuation trend was more stable.The incidence of postoperative abdominal distention in group H was less than that in the other two groups?P<0.05?.The results of blood gas analysis showed that there was no significant statistical difference in acid-base balance?p H value,anion gap,blood lactate?,electrolyte level?sodium ion,potassium ion,chloride ion?between the three groups?P<0.05?.The postoperative albumin of the three groups decreased compared with that before the operation?P<0.05?,but there was no statistical difference between the three groups.There was no significant difference in renal function between the three groups before and after operation.The incidence of anastomotic leakage in group C was higher than that in Group R and H,but the difference was not statistically significant.There was no significant difference in the incidence of other postoperative complications among the three groups.The incidence of infection in Group R was higher than that in group C and H?P<0.05?.Conclusion In laparoscopic radical resection of colorectal cancer,there were less hemodynamic changes in crystalloid-colloid restricted fluid group,with less amount of fluid consumption.In terms of postoperative intestinal function recovery and complications,the incidence of abdominal distention and incision infection was lower,anastomotic leakage was relatively reduced,and there was no occurrence of obvious renal impairment and coagulation dysfunction.In conclusion,in laparoscopic radical resection of colorectal cancer,the clinical effect of crystalloid-colloid restricted fluid regimen is better. |
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