Effects Of 6% Hydroxyethyl Starch 130/0.4 In A Balanced Electrolyte Solution On Hepatorenal And Coagulation Functions In Elderly Patients

Objective:To observe the hepatorenal and coagulation functions in elderly patients undergoing total hip arthroplasty after infusion of different fluids which were directed by stroke volume variation.And to investigate the effect of intraoperative infusion 6%hydroxyethyl starch 130/0.4 in a balanced electrolyte solution on the hepatorenal and coagulation functions of elderly patients.Methods:150 selected elderly patients undergoing elective total hip arthroplasty were randomly divided into three groups:the 6%hydroxyethyl starch 130/0.4 saline solution(HES-SAL)group,the 6%hydroxyethyl starch 130/0.4 electrolyte solution(HES-BLA)group and the sodium lactate ringer(LACR)group.Patients received routine anesthesia induction after entering the operating room.Radial artery was punctured to monitor the invasive arterial pressure(LAP)and cardiac index(CI),as well as stroke volume variation(SVV).The breathing rate was adjusted on the basis of the carbon dioxide at the end of expiration.Blood gas analysis was completed after anesthesia and at the end of operation.During the Anesthesia period,each group used the corresponding solution to implement the goal-directed fluid therapy(GDFT).It was considered that the two kinds of liquid volume therapies was equivalent if the difference between liquid dosages was equal to or smaller than 500 ml.The primary indicator was hepatorenal functions defined by changes in blood and urine concentration of cystatin C(CysC)before,immediately after and one day after the operation.Meanwhile,the serum creatinine(Cr)concentration,glomerular filtration rate(GFR),Urea(Ur)concentration on the first day after operation were compared with preoperative baseline concentrations to evaluate renal functions.Liver function was accessed by comparing the concentrations of alanine aminotransferase(ALT),the ratio of aspartate aminotransferase and alanine aminotransferase(AST/ALT)and prealbumin(PA)before and one day after operation.Secondary endpoint was coagulation complications,which was assessed by conventional coagulation examinations,intraoperative blood loss and postoperative wound drainage.Third endpoints were intraoperative electrolyte and acid-base balance levels,such as the concentration of chloride,sodium,potassium and pH in serum.Results:All three fluids could maintain the hemodynamic stability based on the data of experiments.The total infusion amount during operation had no significant statistical significance(P>0.05).Three solutions had no significant effect on the short term hepatorenal functions(P>0.05).Coagulation time was prolonged after operation in all three groups(P<0.05).Compared with other groups,it was found that the pH of HES-BLA group at the end of operation(P<0.05)was higher.The concentration of chloride,sodium and potassium in serum showed no significant statistical significance at each time point.The HES-BLA group had higher prealbumin(PA)one day after the operation(P<0.05)than that of other groups,and the difference was statistically significant.Conclusion:1.Intraoperative infusion of 6%hydroxyethyl starch 130/0.4 electrolyte solution has no obvious effect on the hepatorenal functions and coagulation2.6%hydroxyethyl starch 130/0.4 electrolyte solution has an advantage in maintaining the acid-base balance in vivo.