ABSTRACT
Objective To compare the influence of liberal fluid therapy, goal-directed fluid therapy and restrictive fluid therapy on inflammatory factors and postoperative recovery in patients undergoing laparoscopic colectomy, and find an optimal fluid therapy strategy for intestinal surgery. Methods Ninety colon carcinoma patients who had underwent laparoscopic colectomy at Shengjing Hospital Affiliated to China Medical University from April 2018 to February 2019 were selected. The patients were divided into control group (liberal fluid therapy), observation Ⅰgroup (goal-directed fluid group) and observationⅡgroup (restrictive fluid group) according to random digits table method with 30 cases each. The intraoperative liquid intake and output volume, surgery duration, albumin variation, first exhaust time, postoperative hospital stay and complications were recorded; the plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) before surgery and at the time of leaving post-anesthesia care unit (PACU) were measured. Results The intraoperative crystal solution volume, total fluid volume and urine output in control group were significantly higher than those in observationⅠgroup and observationⅡgroup: (3 113.3 ± 535.9) ml vs. (2 443.3 ± 559.7) and (2 065.0 ± 411.3) ml, (3 703.3 ± 656.4) ml vs. (3 120.0 ± 546.9) and (2 546.7 ± 455.2) ml, (1 078.3 ± 475.4) ml vs. (423.3 ± 222.7) and (299.2 ± 203.1) ml, those in observation Ⅰ group were significantly higher than those in observation Ⅱgroup, and there were statistical differences (P＜0.05). There was no statistical difference in blood loss volume among 3 groups (P＞0.05). There were no statistical differences in IL-6, TNF-α and CRP before surgery among 3 groups (P＞0.05). When leaving PACU, the IL-6 and TNF-α in observationⅡgroup were significantly higher than those in control group and observationⅠgroup: (26.2 ± 5.4) ng/L vs. (22.2 ± 4.9) and (21.4 ± 4.5) ng/L, (38.5 ± 2.6) ng/L vs. (32.5 ± 1.9) and (33.2 ± 1.9) ng/L, and there were statistical differences (P＜0.05); there was no statistical difference in CRP among 3 groups (P＞0.05). There were no statistical differences in surgery duration, albumin variation and incidence of complications among 3 groups (P＞0.05). The first exhaust time in observationⅡgroup was significantly longer than that in observationⅠgroup: (75.5 ± 35.7) h vs. (51.1 ± 23.8) h, the postoperative hospital stay in observationⅡgroup was significantly longer than that in control group and observationⅠgroup: (15.1 ± 2.8) d vs. (12.1±2.7) and (12.5 ± 3.5) d, and there were statistical differences (P＜0.05). Conclusions Compared with the restrictive fluid therapy, liberal and goal-directed fluid therapy are able to reduce inflammatory response and the length of postoperative hospital stay in patients undergoing laparoscopic colectomy. While goal-directed fluid therapy has shorter first exhaust time compared with liberal fluid therapy, it prompts early recovery after surgery.