The Effects Of Fluid Management On Perioperative Hemodynamic And Outcome Of Abdominal Surgery In Elderly Patients

Background and objectiveWiththe population aging,the number of elderly patients receive surgery treats increasing day by day,the incidence of various diseases increased sharply,in according to these degenerations of organs,the risk of the elderly patients' anesthesia and surgery is increasing.Because of the mortality, preoperative complications are much higher.than the young patients,it is particularly important to take appropriate fluid management to the elderly patients.Though preoperative fluid therapy is a controversial subject at present,such as the controversy of "dry" and "wet",colloid and crystalloid' s and colloid and colloid' s,etc.There is no conformity of fluid therapy,especially for the elderly patients.Formerly,the doctors thought in the anesthesia the prompt capacity expandsmay improve the circulatory system function,enhances theorgan' s irrigation,but clinical discovery,massive liquid infusion,especially regarding old age patient,not only cannot improve the organization irrigation,moreover also causes each kind of complication the occurrence,causes the condition aggravation..Some studies have found that restrictive volume administration could decrease the positive fluid balance,promote the earlier return of bowel function,lower the incidence of postoperative mortality rate,and decrease the length of postoperative hospital stay.In this study,our primary purpose is to investigate the effect of different restrictive fluid therapies for the elderly patients',abdominal surgery on perioperative hemodynamic,coagulation function,renal and hepatic function and postoperative function recovery.Methods96 ASAâ…¡orâ…¢elderly patients of both sexes(51 males,45 females)aged 65-89 yr weighing 35-73 kg undergoing elective abdominal surgery were randomly allocated into 3 groups:group 1 Lactated Ringer' s Solution(n=33);group 2 Gelatin + Lactated Ringer' s Solution(n=32);group 3 Gelatin(n=31).All patients in this study receive 5ml·kg^-1·h^-1solution throughout the intraoperative period.The HR,SBP,DBP,MAP,CVP,SPO₂,P_ET-CO₂ were recorded respectively at the time of pre-anesthesia(T₀),induction(T₁),intubation (T₂),pre-incision(T₃),incision 30 min(T₄),incision 60 min(T₅),incision 90 min(T₆),incision 120 min(T₇),before close(T₈)and end-operation(T₉). Arterial blood gas analysis respectively at the time of T₃ and T₈ Blood coagulation,liver and renal function were tested respectively at the time of before operating,the day after operation.Blood loss,urine output,and doses of drugs(fentanyl,propofol,vecuronium,remifentanil)given during the surgical procedure,the need to start vasoactive infusion and the were volume of fluid were recorded.Analysis is performed to using the Statistical Analysis System software SPSS 13.0.All the quantitative darns of the three groups are compared with one-way analysis of variance(ANOVA),the categorical data with chi-square test.P＜0.05 is considered to represent statistical significance.Result1.There was no significant difference in using of Vasoactive drugs in three groups(P＞0.05).2.There were have similar trend of HR,SBP,DBP,MBP among three groups, the HR of group 2 in T5 and the group 3 in T7,T8,T9 are significantly slower than group 1(P＜0.05).the CVP have increased tendency in three groups, Significantly in group3 in time of T5 andT10,CVP increased more than groupl(P＜0.05).there was no significant difference in P_ET-CO₂ among the three groups (P＞0.05).3.pH were significantly decreased in T₁₀compared with T₄ in groupl and group3(P＜0.05)in arterial blood gas analysis,and it significantly decreased more in group3 than groupl;There were significantly increased in PaCO₂ in groupl and group3(P＜0.05);There was no significant difference in lactate level in T₁₀compared with T₄.4.There were no significant difference in the fluid management in the 2 postoperative days among three groups(P＞0.05).5.The WBC counts and NE%are both significantly increased in three group in postoperative,but the WBC of groupl significantly increased more than other groups(P＜0.05);There were significantly lower level in hematocrit(Hct), platelet(PLT),albumin(ALB),MG(GOLB)in postoperative;Hct,PLT and ALB of group 3 significantly reduced more than group 1 and 2(P＜0.05).6.There were no significantly changed in Creatinine,Urea nitrogen,K⁺ and Cl^- in the postoperative compared with the preoperative in all patients (P＞0.05);But the Na⁺ was significantly reduced in three group(P＜0.05).7.There were significant longer in PT,INR and significant lower in AT of postoperative compared with preoperative in three groups.In group3,PT was significantly increased longer than groupl and group2(P＜0.05);The AT of group3 was significantly lower than other groups.The APTT of group2 and group3 was significantly longer than preoperative(P＜0.05).8.There were no significant difference in postoperative hypertension, arrhythmia,poor wound healing,heart failure,high fever,nausea,Vomiting, abdominal distention,abdominal infection,low blood pressure and mortality statistics(P＞0.05).There were no significant differences among the three groups in the time of postoperative flatus and feces feed and duration of postoperative hospital stays.Conclusion1.Elderly patients with abdominal surgery intraoperative received 5ml·kg^-1·h^-1,Colloid solution or cocktail solution(Crystalloid and Colloid, 1:1 mixture)could have maintain the circulating system stability,but Colloid solution could have maintain high CVP than Crystalloid solution.2.Intraoperative fluid therapy did not have any different effects on arterial blood gas analysis in three groups.But it could have maintained the pH stability with cocktail solution.3.WBC increased obviously in group Crystaltoid;Hct,Hb,Alb decreased obviously in group Colloid.4.The blood coagulation function was well maintained in postoperative in all patients,but it showed a low tendency in group Colloid.5.The complications and rehabilitation have no difference in three groups.