Effects Of Physiological Requirement With Different Ratio Of Crystalline To Gum On Hemodynamics And Oxygen Supply And Consumption After Anesthesia Induction

Objective:Our study aims to observe the changes of hemodynamics,oxygen supply and oxygen consumption in patients with Hepatic lobectomy by infusion of whole crystalloid,crystalloid to gelatin ratio of 1:1,crystalloid to gelatin ratio of 1:2,and gelatin to crystalloid ratio of 2:1.Methods:32 patients with hepatic lobectomy were selected from our hospital.Inclusive criteria:cardiac function ??? grade,age 18?55 years,BMI 1 8.5?26.Exclusion criteria:severe renal insufficiency;Patients with myocardial infarction in the past 6 months;Cardiac insufficiency(???V);Severe obesity(BMI>26 or<18.5);Severe Peripheral Vascular Disease.They were randomly divided into four groups.After the patient entered the operating room,IntelliVue MP50 multifunctional monitor was connected to open the venous access,but fluid infusion was limited.Under 1%lidocaine local anesthesia,radial artery puncture was connected with FloTrac flow pressure sensor,and the other end was connected with Vigileo for continuous cardiac output monitoring.Under local anesthesia with 1%lidocaine,the right internal jugular vein was cannulated and connected with liquid and limited infusion,and connected with disposable pressure sensor.Arterial blood gas analysis and central venous blood gas analysis were performed.(Hb),calculating the oxygen supply of the patient(DO2);The basic oxygen saturation(SvO2)and partial pressure of oxygen(PvO2)were measured by central venous blood gas analysis,and the oxygen consumption(VO2)was calculated.Then group A was supplemented with compound electrolytes;Group B was supplemented with crystal compound electrolyte and colloidal hydroxyethyl starch at the ratio of 1:1;Group C was supplemented with crystal compound electrolyte and colloidal hydroxyethyl starch according to the ratio of crystal to colloidal starch 1:2;Group D was supplemented with crystal compound electrolyte and colloidal hydroxyethyl starch according to the ratio of crystal to colloidal starch 2:1.The baseline values of T0,20%(T20),40%(T40),60%(T60),80%(T80)and 100%of physiological requirements for infusion were recorded when the patient entered the operating room.The baseline values are mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),stroke volume(SV),cardiac index(CI),systemic vascular resistance(SVR),central venous pressure(CVP).Then,Mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),stroke volume(SV)cardiac index(CI),systemic vascular resistance(SVR)and central venous pressure(CVP)were measured at 1,3,5 and 10 minutes after anesthesia induction.When systolic blood pressure(SBP)was lower than 90 mmHg during induction,norepinephrine(NE)was used to correct the blood pressure(BP).Height,weight.and the number of times norepinephrine was used during induction were recorded.Arterial blood gas analysis and central venous blood gas analysis were performed after 100%physiological requirement infusion.Arterial blood gas analyses were performed to record basic lactate(Lac).basic arterial partial pressure of oxygen(PaO2),basic arterial oxygen saturation(SaO2)and basic hemoglobin(Hb).Oxygen delivery(DO2)was calculated;The basic oxygen saturation(ScvO2)and the basic venous partial pressure of oxygen(PvO2)were recorded by central venous blood gas analysis,and the oxygen consumption(VO2)was calculated.Results:There were no significant differences in mean arterial pressure,peripheral resistance,central venous pressure,cardiac output.cardiac index,stroke volume and heart rate among the four groups at T0,T20,T40,T60,T80 and T100(P>0.05).Mean arterial pressure(MAP),peripheral resistance(PR),central venous pressure(CVP),cardiac output(CO).cardiac index(C1).stroke volume(SV)and heart rate(HR)decreased significantly at I1,I3,I5 and I10 compared with their respective T0 and T100 time points(P<0.05).The decrease was more obvious in the whole crystalloid group than that in the mixed crystalloid and colloid group(P<0.05).There were no significant differences in mean arterial pressure,peripheral resistance,central venous pressure,cardiac output,cardiac index and stroke volume among I1,I3,I5 and I10(P>0.05).There was significant difference in the times and dosage of vasoactive drugs between the two groups(P<0.05).There was no significant difference in lactate,oxygen supply and oxygen consumption among the four groups before and after infusion of physiological requirement(P>0.05).Conclusion:Compared with crystalloid and colloid mixture infusion,crystalloid and colloid mixture infusion can maintain hemodynamic stability better.