The Clinical Observativation On Esophaged Doppler Directing Transfusion In Patients Undergoing Hepatoma Surgery

Objective: To evaluate the clinical observativation onesophaged Doppler directing transfusion, through researchinghemodynamics and immunologic function in patientsundergoing hepatoma surgery.Methods: Forty ASAâ… ,â…¡patients were included, aged40～60years, weight 60～80kg, Hb≥11.0g/l, Hct≥0.33, withoutendocrine, immunity disease, undergoing lobectomy of liver.Forty patients were randomly divided into two groups: group ofnormal liquid (group N, n=20), group of esopheged Dopplerdirecting transfusion (group S, n=20). All patients were notgiven premedicant, were routinely monitored MAP, HR, ECG,SpO₂, were established intravenous passage. Anesthesia wasinduced with fentanyl 5μg·kg^-1, propofol 1-2 mg·kg^-1,rocuronium 0.6 mg·kg^-1. After tracheal intubation, the patientswere mechanically ventilated (Tidal Volume=8～10 ml·kg^-1,respiratory rate=14bpm, I: E=1:2). Anesthesia was maintainedwith isoflurance, P_ETCO₂ was maintained at 35～45mmHg,during operation BIS was maintained at 40～50 by intermittent ivfentanyl 2μg·kg^-1, atracurium 0.2mg·kg^-1 was intermittentinjected by intravenous according the TOF. After tracheal intubation esophaged Doppler was implanted by nasal cavity ororal for monitoring SV, LEVT_C. In group N the normal fluidinfusion introduced by《Anaesthesiology》(third edition) wasimplemented. In group S the fluid therapy was implementaccording the Sinclair's method. MAP, HR, SV, LVET_C wererecorded at the time of arriving operation room(T₁), afterinduction(T₂), at the beginning of the operation(T₃), portahepatic blockage(T₄), 15min after porta hepatic open(T₅), theend of the operation(T₆). The time of the operation, the time ofporta hepatic blockage, crystalloid requirements, colloidrequirements, unrnary output was recorded. The blood sampleswere collected from median cubital vein at the time of arrivingoperation room(T1), the end of the operation(T6), and standedat the room temperature and separated by centrifugation andstored at-70℃. The blood samples were measured bymonoclonal antibody RIA for TNF-α, IL-2, IL-4, IL-6, IL-8.Results: 1 The general information In the two groupsthere were no significantly difference in ages, the rate of sex,body weight index, time of the operation, time of porta hepaticblockage, the value of blood loss (P＞0.05). The total liquidvolume and crystals volume in group N was more than in groupS (P＜0.05). The number of collold and the amount of urine ingroup S was more than in group N (P＜0.05)2 The data of the hemodynamics2.1 LVET_C: The LVET_C was shorter than 0.35s at T₂, therewas no significantly difference in the two groups (P＞0.05) Compared with T₂, in the two groups the LVET_C increased fromT₃ toT₆ (P＜0.05); in group S the LVET_C increased to 0.35s at T₃and waved in 0.35s～0.4s during the operation; in group N theLVET_C increased to 0.35s at T₅. In any time the LVET_C in groupS was longer than in group N (P＜0.05)2.2 SV: Compared with T₂, the SV increased gradually duringthe operation in the two groups (P＜0.05). In group S the SVwas higher than in group N in any time (P＜0.05)2.3 MAP: There was no significantly difference in the twogroups at T₁(P＞0.05). Compared with T₁, in the two groups theMAP decreased at T₂ (P＜0.05), increased gradually after fluidinfusion. In group N the MAP increased to base level at T₄ andwas higer than base level at T₅, T₆. In group S the MAPincreased to base level at T₃ was higer than base level in any timeduring the operation (P＜0.05). In any time the MAP in group Swas higer than in group N (P＜0.05).2.4 HR: There was no significantly difference in the two groupsat T₁, (P＞0.05). Compared with T₁, the MAP increased at T₂ inthe two groups (P＜0.05), decreased to base level during theoperation. There was no significantly difference in the twogroups during the operation (P＞0.05)3 Adverse event of hemodynamicsThe adverse event of hemodynamics in group N were higer thanin group S (P＜0.05).4 Inflanmmatory markers:4.1 TNF-α,IL-6,IL-8 Compared with T1, in the two groups the expressions of TNF-α,IL-6, IL-8 increased significantly at T₆(P＜0.05). Compared withgroup N, in group S the expressions of TNF-α, IL-6, IL-8 wasless than in group N (P＜0.05)4.2 IL-2, IL-4Compared with T1, in the two groups the expressions of IL-2and IL-4 increase significantly at T₆ (P＜0.05). Compared withgroup N, in group S the expressions of IL-2 and IL-4 was lessthan in group N (P＜0.05)Conclusions: 1 Esophaged Doppler directing transfusioncan maintains hemodynamic steadily and offers the best bloodvolume, alleviates inflammatory reaction, improves immunityfunction.