Pankreatikoduedonektomi Yapılan Hastalarda Intraoperatif Sıvı Tedavisinin Postoperatif Elektrolit Seviyeleri Üzerine Etkilerinin Retrospektif Değerlendirilmesi

Abstract

The aim of this study was to investigate the effects of intraoperative fluid administration on postoperative electrolyte levels and renal function tests in patients undergoing pancreaticoduedonectomy. Following ethical commitee approval; files of 120 patients who had undergone pancreaticoduedonectomy were investigated. The effects of the type and amount of fluid administrated intraoperatively on postoperative Na, Cl, K, BUN, creatinine and glucose levels were studied. The data of patients was compared by using Kolmogorov-Smirnow, t-test, Kruskal-Wallis and Wilcoxon tests and values of p<0.05 were accepted as statistically significant. In our study, it was observed that Isolyte-S, a balanced electrolyte solution, had been administered to all patients thoroughout the intraoperative period and according to hemodynamic parameters, colloid solutions (voluven, fresh frozen plasma) and packed red blood cells had been given. When we compared preoperative and postoperative renal fuction tests and electrolyte levels; there was a significant increase in Na, K and BUN levels but no difference in creatinine and Cl levels. Patients were seperated into 3 groups according to the amount of voluven solution received, none versus 500 ml voluven and 1000 ml voluven, to find out the effect of intraoperative voluven therapy. While there was an increase in Na and K levels in patients who did not receive any voluven solution, we observed a significant increase in Cl (1,2 mmol/L) Na, K, BUN and creatinine levels in patients who had been given 1000 ml voluven. It’s thought that the increased Na and Cl levels are caused by the % 0,9 NaCl content of voluven solution. Throughout the sudy all electrolyte increases were minimal, especially increases in Na not clinically significant. vi We did not observe any significant difference in urine output between the 3 groups. In our study we found out that patients were administered 8,5 ml/kg/hr total fluid during the intraoperative period and this is consistent with the restrictive fluid therapy protocols in the litrature. According to findings obtained in our study, we concluded that the use of Isolyte-S and similar balanced electrolyte solutions during long operations with a significant amount of insensible fluid loss like pancreaticoduedonectomy does not have negative effects on postoperative electrolyte levels and renal function tests. Nevertheless, future studies with standardization in timing of checking blood samples are needed and it would be useful to analyze arterial blood gases, electrolytes reflecting renal function in the short term like phosphorus and standardize the amount and type of fluids given during the postoperative period.