| Purposes: Two different restrictive fluid infusion methods were used during the operation on the elderly patients with intestinal cancer to observe the effect of different infusion methods on the recovery of the postoperative intestinal function,postoperative complications and immune function in the elderly patients with intestinal cancer.And the feasibility of the application of different restrictive infusion methods during the anesthesia in the laparoscopic surgery for intestinal cancer in the elderly was explored.Methods: The elderly patients older than 60 years old that received the laparoscopic operation of intestinal cancer during the period from March2017 to December 2017 in the hospital were selected(ASAII-III grade,BMI<32kg/m2,no serious cardiovascular disease,liver and kidney disease history,blood coagulation dysfunction,metabolic disease history,no definite neurological and psychiatric diseases history or history of taking the corresponding drugs,no severe electrolyte disorder,preoperative Hb≥8g/dL,Alb≥30g/L,preoperative measurement of blood pressure≤160/100 mmHg,heart rate≥50s / min,blood glucose≤11.0mmol/L,Two operations or patients with the history of radiotherapy or chemotherapy),and they were randomly divided into two groups: the control group(35 cases of the routine fluid restriction group)and the experimental group(35 cases).The patients were established with venous access,ECG,SPO2,invasive arterial blood pressure,BIS and tempeature monitoring after they entered the room,and after entering the room,the experimental group began to be infused with0.9%Nacl solution to supplement the physiological requirementsfor the preoperative fasting and water deprivation.The infusion was completed before the operation,and the infusion of saline was continued at 2mL/kg/h at the end of the infusion until the end of the operation.The control group received routine fluid restriction after entering the room,and the anesthesiologists could properly limit the ratio of the liquid dosage and crystalline colloid according to the conditions of the patients.Two groups of patients were both treated with midazolam 0.05-0.1mg/kg,etomi date 0.2-0.3mg/kg,sulfentanyl 0.5ug/kg,cisatracurium 0.2mg/kg for the anesthesia indu ction.After the tracheal intubation,the anesthesia was maintained by propofol 4-12mg/(kg/h),remifentanil 0.1-2ug/(kg/h)and dexmedetomidine 0.4 ug/(kg/h).Intravenous inj ection of cisatracurium 0.05-0.1mg/kg on demand was carried out in the operation,and the BIS value should be maintained between 40-60.When MAP<60mmHg or the blood pressure drop exceeded 30% of that before the surgery,and heart rate<40times / min,the vasoactive drugs were given on demand to maintain the hemodynamic stability.HR,MA P,HB,HCT,BE,LAC,BIS,BV at the periods of T1(when the patient entered the room,T2(5min after the tracheal intabation),T3(immediately after the beginning of surgery),T4(1h after the operation),T5(2h after the operation)and T6(at the end of the surgery)were recorded.Total urine volume,total volume of bleeding,volume of total infusion fluid,volume of crystal,and colloid quantity were recorded during the operation of the patient.Cr,BUN,ALT,AST,WBC value of the patient on the day after the surgery and 1,3,5 days after the operation were recorded.The liquid intake on the first day,exhaust defecation time after the operation,time to have semi liquid diet,time to pull out the tube,the flow rate of the drainage tube and the postoperative complications of the patient were also recorded.In the control group and the experimental group,10 patients were randomly selected to be collected the arterial blood 2ml at the periods of T1,T2,T3 and T6,and the number of theT lymphocyte subsets,the number of NK cells and the T lymphocyte subgroup(CD4,CD8)in each period was detected by the flow cytometry.Results:(1)In this experiment,the mean arterial pressure and heart rate were analyzed in each time period of the two groups,and the difference of the mean arterial pressure at each time point was statistically significant(F=14.376,P=0.000);The difference of mean arterial pressure between the experimental group and the routine limited infusion group was statistically significant(F=2.257,P=0.038).At the beginning of operation,the beginning of 30 min after operation,mmediately after operation,the mean arterial pressure of the experimental group was significantly lower than that of the conventional limited infusion group,and the difference was statistically significant(P < 0.05);(2)The difference in the residual value of alkali at every time point from the patient sentrance to the room to the end of the operationwas statistically significant(F=8.752,P=0.000).;There was no statistical significancce in the difference between the experimental group and the routine restriction infusion group(F=0.994,P=0.324);The residual value of alkali of the two groups of patients fluctuated at different time points,but the fluctuations of the experimental group were significantly higher than that of the routine restriction infusion group.The difference of LAC value at each time point from the patient sentrance to the room to the end of the operation was statistically significant(F=2.890,P=0.043);There was no statistical significancein LAC difference between the experimental group and the routine infusion group(F=1.336,P=0.253);The LAC value of the patients in the experimental group was slightly higher than that of the routine restriction infusion group at the moment of PACU,but the difference was not statistically significant.(3)For the total amount of liquid infusion in the two groups during anesthesia,the experimental group was less than the routine restriction infusiongroup,and the difference was statistically significant(P<0.05);For the total amount of0.9%Nacl infusion in the two groups during anesthesia,the experimental group was larger than the routine restriction infusion group,and the difference was statistically significant(P<0.05);For the total amount of hydroxyethyl starch infusion in the two groups during anesthesia,the experimental group was less than the routine restriction in fusion group,and the difference was statistically significant(P<0.05);For the total volu me of urine in the two groups during anesthesia,the experimental group was less than th e routine restriction infusion group,and the difference was statistically significant(P<0.05);For the vasoactive drug use in the two groups during anesthesia,the experimental gr oup was larger than the routine restriction infusion group,and the difference was statistc ally significant(P<0.05).(4)The input volume in 24 hours after the operation in the exp erimental group was less than that in the routine restriction infusion group,and the diffe rence was statistically significant(P<0.05);The output volume between the groups in 24 hours was not statistically different.(5)The first exhaust time,first defecation time,tim e to eat semi liquid diet,time to pull out the drainage tube,drainage volume,the number of half stream cannibals at discharge and the number of non draining drainage tubes at d ischarge of the two groups were compared and analyzed,and there was no difference be tween the two groups.There was no statistical difference between the two groups of pat ients in the number of the adverse reactions related to the postoperative intestinal func tion recovery and the number of the complications related to the intestinal surgery.Ther e was no statistical difference between the two groups in the postoperative respiratory a nd circulatory systems.In the experimental group,a case of stroke and one case of pulm onary infection occurred,and other systemic complications occurred.(6)There was no s tatistical difference between the two groups in the number of the in-hospital days after the operation.(7)There was no difference in the rates of decline of the total number of T lymphocytes,the number of NK cells in the total number of T lymphocytes,and the nu mber of NK cells between the two groups at the time periods of the entrance to the room and the end of the operation.There was no difference in the rise rate of CD4 / CD8 ratio between the two groups at the time periods of the entrance to the room and the end of th e operation.Among the four time points,the total number of T lymphocytes and the nu mber of NK cells were the lowest at the time period of the beginning of the operation,while the CD4 / CD8 ratio was the highest at the the time period of the beginning of the operation.Conclusion: The results of this study suggest that two kinds of restrictive liquid infusion methods can be used in the elderly laparoscopic operation of intestinal cancer,but the hemodynamic fluctuation of the experimental group is more obvious and the use of vasoactive drugs is more.In contrast,the routine restrictive infusion group may be more safe and feasible. |
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