Effects Of Different Crystalloid Fluid Infusions On Internal Environment,hepatic,renal And Coagulation Function In Patients Undergoing Liver Tumor Resection

Objective:To investigate the effects of intraoperative infusion of different crystalloid solutions on the internal environment,hepatic and renal function,coagulation function,and normal liver tissue edema around the liver mass in patients undergoing liver tumor resection.Methods:A total of 120 patients undergoing elective liver tumor resection in our hospital were selected.Patients with ASA grade I～III were randomly divided into sodium acetate ringer injection group（ARS group）,sodium lactate ringer injection group（LR group）,sodium potassium magnesium calcium and glucose injection group（SPMCG group）and normal saline group（N group）.There were 30 cases in each group.Four groups were infused corresponding experimental liquid 500 ml with the rate 15 ml?kg^-1?h^-1 before anesthesia induction,followed by a 10 ml?kg^-1?h^-1 rate for 2 h,Finally,the infusion rates were maintained according to the central venous pressure（CVP）,urine output and intraoperative conditions until the surgery was finished.Electrolyte,acid-base balance,blood lactic acid and blood glucose were measured before infusion（T₀）,1 h after infusion（T₁）,2 h after infusion（T₂）,immediately after hepatic hilar block（T₃）,5 min after hepatic hilar reopening（T₄）,and immediately after leaving PACU（T₅）.Hepatic,renal and coagulation function were detected before surgery（Pre）,the day after surgery（P₀）and 1day after surgery（P₁）.The dry-wet weight ratio of normal liver tissue around the liver mass was also recorded.Results:There was no significant differences in general characteristics among all groups.The results of other indicators are as follows.（1）Changes of blood electrolytes.Blood K⁺concentration:There was no significant differences in K⁺concentration among all groups at T₀ time point（P>0.05）.Compared with T₀ time point,there was no significant change in K⁺concentration at all time points postinfusion in each group（P>0.05）,and all values were within normal range.All the time points postinfusion,there was no statistical difference in K⁺concentration across groups（P>0.05）.Blood Na⁺concentration:There was no significant differences in Na⁺concentration among all groups at T₀ time point（P>0.05）.Compared with T₀ time point,there was no significant change in Na⁺concentration in ARS group,LR group and SPMCG group at all time points postinfusion（P>0.05）.The Na⁺concentration of group N at T₅ time point after infusion was significantly higher than that at T₀ time point（P<0.05）,but all of them were within the normal range.All the time points postinfusion,there was no statistical difference in Na⁺concentration across groups（P>0.05）.Blood Ca²⁺concentration:There was no significant differences in Ca²⁺concentration among all groups at T₀ time point（P>0.05）.Compared with T₀ time point,there was no significant change in Ca²⁺concentration in ARS group,LR group and SPMCG group at all time points after infusion（P>0.05）.After infusion,the Ca²⁺concentration in group N decreased significantly at T₁-T₅ time points compared to T₀time point（P<0.05）,but all were within the normal range.There was no statistical difference in Ca²⁺concentration among all groups at T₁and T₅time points（P>0.05）,the Ca²⁺concentration in the N group at T₂-T₄time point was significantly lower than that in the other three groups（P<0.05）.（2）Changes of acid-base balance.PH value:T₀ time point,there was no significant differences in PH value among all groups（P>0.05）.Compared with T₀ time point,PH value of ARS group,LR group and SPMCG group significantly decreased at T₂,T₄,T₅time point（P<0.05）,the PH value of group N at T₁-T₅ time point was significantly lower than that at T₀time point（P<0.05）,and all PH value changes were still within the normal range.There was no statistically significant difference in PH value between all groups at T₁-T₃time points（P>0.05）,the PH value of group N at T₄and T₅ time points was significantly lower than that of ARS group and SPMCG group（P<0.05）.BE value,HCO₃^-concentration:At T₀ time point,there was no significant differences in BE value and HCO₃^-concentration among all groups（P>0.05）.Compared with T₀time point,BE value and HCO₃^-concentration of all groups were significantly decreased within the normal range at all time points after infusion（P<0.05）.There was no statistically significant difference in BE and HCO₃^-concentration between all groups at T₁-T₄ time points（P>0.05）.At T₅ time point,BE value and HCO₃^-concentration in group N were significantly lower than those in the other three groups（P<0.05）.PCO₂:There was no statistically significant differences in PCO₂ between and within the four groups（P>0.05）.（3）Changes of blood Lac concentration and Glu concentration.Blood Lac concentration:There was no significant differences in Lac concentration between all groups at T₀ time point（P>0.05）.Compared with T₀ time point,Lac concentration in ARS group,SPMCG group and N group significantly increased at T₂ and T₄time points after infusion（P<0.05）.The Lac concentration at the T₁-T₄ time point of the LR group was significantly higher than that at the T₀time point（P<0.05）.All the time points postinfusion,there was no statistical difference in the Lac concentration across groups（P>0.05）.Glu concentration:There was no significant differences in Glu concentration between all groups at T₀ time point（P>0.05）.Compared with T₀ time point,Glu concentration in ARS group and N group increased significantly at T₂ and T₄ time points after infusion（P<0.05）.In the LR group,Glu concentration at T₂-T₅time points was significantly higher than the T₀time point（P<0.05）,and the Glu concentration in SPMCG group at T₁-T₅ time points was significantly higher than the T₀time point（P<0.05）.There was no statistical difference in the Glu concentration among all groups at T₁ time point（P>0.05）.At the T₂-T₄ time points,the Glu concentration in the SPMCG group was significantly higher than the corresponding time point in ARS group and N group（P<0.05）.At T₅ time point,the Glu concentration in SPMCG group and LR group was significantly higher than that in ARS group and N group（P<0.05）.（4）Changes of liver function.AST and ALT concentration:There was no significant differences in AST and ALT concentration between all groups before surgery（P>0.05）.Compared with pre-operation,the AST and ALT concentration in all groups increased gradually after surgery（Pre<P₀<P₁,P<0.05）,and all values are beyond the normal range.There was no statistical difference in AST and ALT concentration among all groups at all time points after the operation（P>0.05）.TBil concentration:There was no significant differences in TBil concentration among all groups before operation（P>0.05）.Compared with pre-operation,TBil concentration in each group increased significantly on the day after surgery and 1 day after surgery（Pre<P₀,P₁,P<0.05）,There was no statistical difference in TBil concentration between the day after surgery and 1 day after surgery in all groups.There was no statistically significant difference in TBil concentration among all groups at all time points after the operation（P>0.05）.（5）Changes of renal function.Cr and BUN concentration:There were no significant differences in Cr and BUN concentration between all groups before operation（P>0.05）.Compared with pre-operation,there were no significant changes in Cr and BUN concentrations in the ARS group,LR group and SPMCG group（P>0.05）.In N group,the concentration of Cr and BUN on the day after surgery were significantly higher than those on pre-operation and 1 day after operation（P₀>Pre,P₁,P<0.05）,all were within the normal range,and there was no statistical difference in Cr and BUN concentration between pre-operation and 1 day after surgery in all groups.There was no statistical difference in Cr and BUN concentration among all groups at all time points after operation（P>0.05）.（6）Changes of coagulation function.APTT:There was no statistically significant differences in APTT between and within the four groups（P>0.05）.PT:There was no significant differences in PT among all groups before operation（P>0.05）.Compared with pre-operation,PT was gradually increased in four groups at all time points after operation（Pre<P₀<P₁,P<0.05）.There was no statistically significant difference in PT among all groups at all time points after surgery（P>0.05）.（7）Dry-wet weight ratio of liver tissue.There was no statistically significant differences in the dry-wet weight ratio of normal liver tissue around the mass among all groups（P>0.05）.Conclusion:Among the four crystal solutions,sodium acetate ringer injection is most suitable for intraoperative infusion during liver tumor resection.Since sodium lactate ringer injection can cause a more significant increase in lactic acid concentration,an appropriate dose of normal saline is more suitable for infusion during hepatectomy.