Evaluation Of Optimal Preoperative Fluid Management With Different Crystal-gel Ratios In Laparoscopic Hepatectomy

Objective(s):This study was designed to evaluate the effect of Optimizing preoperative fluid management with different crystal-gel ratios on hemodynamics,oxygen supply and demand balance before and after optimization and during operation and patients’ prognosis in patients undergoing laparoscopic hepatectomy.Methods:This study was a s prospective randomized controlled study.Sixty patients undergoing elective laparoscopic hepatectomy in the second affiliated hospital of kunming medical university were recruited from June 2020 to December 2020.Which were randomized into Holocrystalline group(group A),crystal-gel ratios 1:1 group(group B),crystal-gel ratiosl:2 group(group C),crystal-gel ratios 2:1 group(group D),with 15 cases in each group.Compound electrolyte was used as the crystal solution and hydroxyethyl starch solution as the colloidal solution.When the patient entered the operating room,catheterization of the radial artery and right internal jugular vein was performed under local anesthesia and CVP,Flotrac/Vigileo cardiac output was monitored.All patients received liquid infusion that Physiological requirements was caused by preoperative fasting at speed of 0.3mL/(kg.min).All patients received the same anesthesia induction,maintenance,and fluid management regimen.Intraoperative hemodynamic indexes and oxygen supply and oxygen consumption were the main observation indexes.Arterial blood gas analysis was performed when patients entered the operating room(T0),after liquid optimization(Ti),5min after hepatic parenchyma detachment(T5),ILactic acid(Lac)and central venous oxygen saturation(ScvO2)were recorded,and oxygen supply(DO2)and oxygen consumption(VO2)were calculated.Recording Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),stroke volume(SV),cardiac output(CO),systemic circulation resistance(SVR)at T0,infusion physiological requirements 20%(T20%),40%(T40%),60%(T60%),80%(T80%),100%(T1),5min after anesthesia induction(T2),5min before hepatic parenchyma detachment(T3),mid-hepatic parenchyma detachment(T4),5min after hepatic parenchyma detachment(T5),the end of operation(T6).Physiological need missing amount,intraoperative volume,intraoperative blood loss,operative duration,urine volume and intraoperative norepinephrine dose were recorded.The postoperative recovery of patients(postoperative mechanical ventilation time,exhaust time,postoperative hospital stay,ICU stay,postoperative complications)was recorded.SPSS 26.0 was used for statistical analysis after data collection.Results:(1)Hemodynamic changes before and after fluid optimization:There were no significant differences in MAP,SV,CO,CVP and SVR among different groups at each time point(P>0.05),compared with time To,CVP,SV and CO were significantly increased and SVR decreased in all patients at time T1,the differences were statistically significant(P<0.05).(2)Comparison of intraoperative hemodynamic changes:There were no significant differences in MAP,CO and SV among different groups at each time point(P>0.05).The intraoperative dose of norepinephrine was statistically different among different groups(F=12.42,P<0.05),the dose of group A was higher than that of group B and C;Group B was less than group D,group C was less than group D(P>0.05).(3)Comparison of oxygen supply and oxygen consumption:there were no statistically significant differences in DO2,VO2,ScvO2 and Lac among different groups(P>0.05).(4)There were no significant differences in the amount of abstinence and fasting,total intraoperative fluid intake,intraoperative blood loss,duration of operation and urine volume among all groups(P>0.05),and the difference in portal occlusion time was statistically significant(P<0.05).(5)Postoperative recovery:The difference of postoperative liver function was statistically significant(P<0.05).There were no significant differences in postoperative mechanical ventilation time,exhaust time,postoperative hospital stay,ICU stay,postoperative complications and renal function(P>0.05).Conclusion(s):1.Preoperative fluid management was optimized by using liquid of crystal-gel ratios 1:1 and crystal-gel ratios 1:2,and the intraoperative dose of vasoactive drugs was low,which was conducive to maintaining the stability of hemodynamics during laparoscopic hepatectomy.2.Supplementation of the physiological requirements of abstainance and fasting before surgery can optimize the hemodynamic parameters of patients undergoing laparoscopic hepatectomy before anesthesia induction,and does not affect the implementation of intraoperative low central venous pressure and intraoperative blood loss.