Effect of intraoperative fluid management on outcome after intraabdominal surgery
Effect of intraoperative fluid management on outcome after intraabdominal surgery
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DOI：
10.1097/00000542-200507000-00008
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发表时间：
2005-07-01
期刊：
影响因子：
8.8
通讯作者：
Matot, I
中科院分区：
文献类型：
--
作者：
Nisanevich, V;Felsenstein, I;Matot, I
背景资料：正确的围手术期液体management.Methods的争论是悬而未决的：两个术中液体制度对术后结果的影响进行了前瞻性评估，在152例患者与美国麻醉医师协会的身体状况的I-III谁正在接受择期腹腔内手术。患者被随机分配到术中接受自由（自由方案组[LPG]，n = 75;推注10 ml/kg，随后12 ml（.）kg（-1）（.）h（-1））或限制性（限制性方案组[RPG]，n = 77; 4 ml（.）kg（-1）。h（-1））量的乳酸林格氏溶液。主要终点是死亡或发生并发症的患者数量。次要终点包括肛门排气和粪便的初始通过时间，住院时间，以及术后前3天体重，红细胞压积和血清白蛋白浓度的变化。结果：RPG中并发症的患者数量较低（P = 0.046）。LPG组的患者排气和排便明显较晚（肠胃气，中位数[范围]：LPG组4 [3-7]天，RPG组3 [2-7]天; P < 0.001;粪便：LPG组6 [4-9]天，RPG组4 [3-9]天; P < 0.001），术后住院时间显著延长（LPG组9 [7-24]天vs. RPG组8 [6-21]天; P = 0.01）。LPG组体重增长幅度显著大于RPG组（P < 0.01）。在术后的前3天，红细胞压积和白蛋白浓度显着较高的RPG相比，LPG.Conclusions：在择期腹腔内手术的患者，术中使用限制性液体管理可能是有利的，因为它降低了术后发病率，缩短了住院时间。
Background: The debate over the correct perioperative fluid management is unresolved.Methods: The impact of two intraoperative fluid regimes on postoperative outcome was prospectively evaluated in 152 patients with an American Society of Anesthesiologists physical status of I-III who were undergoing elective intraabdominal surgery. Patients were randomly assigned to receive intraoperatively either liberal (liberal protocol group [LPG], n = 75; bolus of 10 ml/kg followed by 12 ml (.) kg(-1) (.) h(-1)) or restrictive (restrictive protocol group [RPG], n = 77; 4 ml (.) kg(-1). h(-1)) amounts of lactated Ringer's solution. The primary endpoint was the number of patients who died or experienced complications. The secondary endpoints included time to initial passage of flatus and feces, duration of hospital stay, and changes in body weight, hematocrit, and albumin serum concentration in the first 3 postoperative days.Results: The number of patients with complications was lower in the RPG (P = 0.046). Patients in the LPG passed flatus and feces significantly later (flatus, median [range]: 4 [3-7] days in the LPG vs. 3 [2-7] days in the RPG; P < 0.001; feces: 6 [4-9] days in the LPG vs. 4 [3-9] days in the RPG; P < 0.001), and their postoperative hospital stay was significantly longer (9 [7-24] days in the LPG vs. 8 [6-21] days in the RPG; P = 0.01). Significantly larger increases in body weight were observed in the LPG compared with the RPG (P < 0.01). In the first 3 postoperative days, hematocrit and albumin concentrations were significantly higher in the RPG compared with the LPG.Conclusions: In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.