Effects Of Fluid Therapy During Anesthesia On Leukocyte Reactivity In Patients Undergoing Orthopaedic Surgery

BackgroundFluid therapy is the top priority in traumatic hemorrhagic shock and perioperative fluid deficits. Adequate and rational fluid therapy is not only restore volume and microcirculation, but also ameliorate the detrimental consequences on the immune function of trauma, shock, and major surgery. Previous studies reveal resuscitation fluids have some impact on leukocyte function. Peripheral blood leukocytes, including neutrophils, lymphocytes and macrophages is the first line of defense in the immune defense, while the neutrophils are thought to play a pivotal role in causing local or systemic inflammatory response and lead to tissue injury and may contribute to organ dysfunction. Therefore, observation of leukocyte reaction during perioperative period should be important in assessing the status of immune function and inflammatory responses, and try to maintain immune function at normal levels or to avoid excessive inflammation by controlling the leukocyte reaction may be helped to reduce perioperative complications and to promote postoperative rehabilitation.ObjectivesThe aim of this study is to investigate the leukocytes reaction in hip or knee arthroplasty patients under combined spinal-epidural anesthesia and different fluid therapy during anesthesia and operation.MethodsIn a randomized single-blinded study, patients who were eligible for the inclusion criteria in the study were randomly assigned to four groups. Patients in gruop LRS infused with lactate Ringer’s solution during surgery, with gelatin6%hydroxyethyl starch solution(HES,130/0.4), or hypertonic sodium chloride hydroxyethyl starch(Home) were belong to groups Gel, HES or Hom respectively. All patients were first infused with500ml lactate Ringer’s solution at the speed of8-10ml·kg-1·h-1. then each group received their Scheduled fluid at the same speed. Patients in hypertonic sodium chloride hydroxyethyl starch groups were given a single dose of250ml Hom(7.5%NaCl, HES,130/0.4) intravenously and maintain with LRS. The infusing speed may be increased when necessary. Blood samples were collected at baseline,40minutes after incision, end of operation, and on the first day after surgery to detect peripheral leukocyte counts and their classification.ResultsAll patients experienced an increase in peripheral leukocyte counts, mainly neutrophil at the end of surgery and the first day after surgery, along with a drop in Lymphocyte Counts.(P>0.05-0.01) There were no significant differences in cell counts and classification in the four groups.(P>0.05)Conclusion1. Peripheral blood leukocytes in patients undergoing hip or knee arthroplasty was slight decreased after anesthesia, and increased at the end of operation and particularly in the first day after surgery.2. The changes in white blood cells count were mainly due to a marked increase neutrophil and decrease in lymphocytes, while the monocytes and macrophage acid cells were also decreased continuously.3. The changes of leukocyte responses perioperative suggest that the immune function tend to in favor of inflammation whereas not to the lymphocyte immune in patients underwent the hip or knee arthroplasty surgery.4.There were no significant deferrant effects of deferent kind of fluid infusuin during surgery on the leukocyte responses, though a short-term of leukocyte response inhibition in groups Gel and HES were not ruled out.