Effects of postoperative restrictive fluid management on recovery of gastrointestinal function after elective colonic resection

Objective To investigate the effect of postoperative restrictive fluid management by ensuring adequate tissue perfusion on the recovery of gastrointestinal function after elective colonic resection.Methods Thirty patients suffered with elective colonic resection,after 6 hours of anesthesia recovery,were randomly divided into restrictive fluid management group (restrictive group,n =15 ) and traditional fluid management group (control group,n =15 ).From the surgery day to the 4th postoperative day,patients in restrictive group and control group received the total fluids of 25-35 ml·kg-1 ·d-1 or 40-50 ml· kg-1 ·d-1 respectively.Fluid balance,tissue perfusion,gastrointestinal function recovery time and the imbalance of fluid and electrolyte were recorded.Results The total fluid input (ml/d) and net fluid balance (ml/d) in restrictive group were significantly fewer than those in control group ( total fluid input:1782.56 ± 258.38 vs.2707.50 ± 294.64,net fluid balance:316.67 ± 202.86 vs.623.33 ± 244.38,both P＜0.05 ),and central venous pressure (CVP,mm Hg,1 mm Hg=0.133 kPa) was significantly lower than that in control group (4.03 ± 1.81 vs.6.47 ± 3.09,P＜0.05 ).There were no differences in heart rate ( HR,bpm ) and mean arterial pressure (MAP,mm Hg) between two groups (HR:85.03 ± 13.49 vs.81.44 ± 12.49,MAP:80.65 ± 11.39 vs.82.38 ± 8.28,both P＞0.05 ).The lactate clearance rate of the first postoperative 24 hours in restrictive group was higher than that in control group [35 ( 17,53 )％ vs.17 (-6,33)％,P＜0.05].The times (hours) of bowel sounds recovery,the first flatus and stool passed in restrictive group were shorter than those in control group (bowel sounds:37.43 ± 24.97 vs.46.36 ± 19.34,flatus:53.63 ± 12.78 vs.75.43 ±20.07,stool:78.73 ±46.48 vs.93.40±41.08,all P＜0.05).Vomiting was reduced in the restrictive group compared with control group (2 vs.7,P＜0.05).There were no differences in the occurrences of electrolyte imbalance ( 5 vs.3 ),fluid insufficient ( 2 vs.0 ) and fluid overload ( 0 vs.1 )between the two groups.Conclusion The postoperative restrictive fluid management by ensuring tissue perfusion can shorten the gastrointestinal function recovery time after elective colonic resection,and may not increase the incidence of water and electrolyte disorders. Key words: Restrictive fluid management;  Tissue perfusion;  Postoperative gastrointestinal tract dysfunction ;  Elective colonic resection ;  Fluid and electrolyte imbalance