The Hemodynamic Effect Of Hypertonic Saline Plus Hetastarch Solution During Anesthesia Induction And Its Protective Effect To The Rat Liver

Objective To observe the hemodynamic effect of hypertonic saline plus hetastarch solution during anesthesia inductionMethods Thirty-six patients ASA I- II patients without cardiac and pulmonary diseases undergoing elective hepatobiliary surgical operations were randomly divided into 3 groups : hypertonic crystal-colloid group(group1: 4 ml/kg),isotonic colloid group(group 2: 7ml/kg) and acetic acid Ringer's solution group(group3:7ml/kg). We administrated radial artery puncture ,then put into Swan-Ganz catheter by jugular vein to monitor hemodynamic parameters.We deployed propofol TCI 4μg/ml, gave 0.75% ropivacaine 8ml by epidural catheter . The hemodynamic parameters were recorded at T1(before infusion),T2(10min after infusion),T3(5 min after induction),T4(5 min after intubation),T5(10 min after intubation),T6(20 min after intubation).Results There were no significant difference of CO,ABPm,PAPm,SV,HR,CI,SI,SVR,PVR at T1 . however, compared with T1 , CO,HR,CI and SI in group 1 increased significantly at T2(P<0.01) ,but SVR decreased at T2(P<0.05). After T3, all CO value declined ,especially in group 3 ,which was lower than baseline value ,however, CO in group 1 changed slightly and relatively kept stable .Compared with group 3, there was a striking increase with SV in group 1 at T4(P<0.05).Meanwhile, CI and SI raised up at T2 and T4(P<0.01). LVSW was high significantly at T6( P<0.01),PVR decreased obviously at T3 and T6(P<0.01). ABPm,LVSW,CVP and PAWP didn't changed obviously compared with other groups and there was a small rangeability in group 1 and group 2 during the whole experiment .The hemodynamic parameters had an outstanding change in group 3 and group 1 was the most stable .Conlusion Compared with isotonic group(group 2: 7ml/kg) and acetic acid Ringer's solution group(group3:7ml/kg), hypertonic crystal-colloid group(group1: 4 ml/kg) can effectively maintain the hemodynamic stabilization during combining general anesthesia with epidural anesthesia.Part 2 The protective effect of hypertonic saline plus hetastarch solution on the rat liver suffered from ischemic and reperfusion injuryObjective To observe the protective effect of hypertonic saline plus hetastarch solution on the rat liver suffered from ischemic and reperfusion injury.Methods Forty male Wistar rats, weighing 300-350 g, were randomized into four groups (n = 10).: hypertonic crystal-colloid group(HSH: Hypertonic saline plus hetastarch solution 40: 10 ml/kg),isotonic colloid group(HES:hetastarch130/0.4:20ml/kg),7.5% hypertonic solution group(HS:20ml/kg) and 0.9% Sodium Chloride(NS:20ml/kg). Pentobarbital sodium (50mg/kg) was used intraperitoneally for anesthesia. ,to undergo vena caudalis catheterization and laparotomy by median abdominal incision, to initiate hepatic ischemia at the end of 15min after finishing infusing the solutions . an atraumatic clip was used to interrupt the lefthepatic veins blood supply to the left of the liver. After 30 minutes of partial hepatic ischemia, the clamp was removed,and liver/blood samples were collected to measure serum alanine amino transferase (ALT) and aspartate amino transferase(AST), the level of superxide dismutase(SOD)and malondialdehyde (MDA)were measured by left liver tissue.the.Samples of other liver tissue were for histologic analysis. Results the significantly increased MDA levels and reduced SOD levels (P < 0.05) were detected in HSH group compared with HES group and NS group ,meanwhile the levels of ALT and AST obviously reduced in HSH and HS group (P < 0.05),the histologic analysis showed that liver damage slighter in HSH than in HES . HSH can be best and significantly protect the liver suffered from ischemic and reperfusion injury .HES was the worst to protect liver tissue suffered from ischemic and reperfusion injury .Conlusion HSH was the most effective in decreasing the liver tissue damage under ischemic and reperfusion conditions compared with HES ,NS and HS .