Lobo D N, Dube M G, Neal K R, Allison S P, Rowlands B J
Section of Surgery, University Hospital, Queen's Medical Centre, Nottingham, UK.
Ann R Coll Surg Engl. 2002 May;84(3):156-60.
Current peri-operative fluid and electrolyte management in the UK may be suboptimal. We assessed the attitudes of consultant surgeons to fluid and electrolyte prescribing and gathered suggestions for improvement in education on the subject.
A postal questionnaire survey was sent to 1091 Fellows of the Association of Surgeons of Great Britain and Ireland. Of the 730 (67%) replies, 20 were invalid or incomplete, and 710 (65%) questionnaires were analysed. Outcome measures included provision of guidelines and teaching to junior staff on fluid and electrolyte prescribing, appropriateness of fluid management and suggestions to improve standards.
Junior staff were given written guidelines in 22% of instances. Only 16% of respondents felt that their preregistration house officers (PRHOs) were adequately trained in the subject before joining the firm; 15% also stated that PRHOs did not receive much training on their firm. 65% felt that fluid balance charts were accurately maintained, nursing shortages being the commonest reason for inaccuracies. Only 30% felt that postoperative patients were receiving appropriate amounts of water, sodium and potassium. Respondents who had been consultants for > 5 years were more likely to prefer erring on the side of under-replacement of fluid than those who were consultants for 5 years (63% versus 47%, P < 0.0005). Suggestions for improvement in education included problem-oriented ward rounds, written guidelines, and discussion of patient scenarios.
Consultant surgeons feel that present practice in peri-operative fluid management is unsatisfactory. Higher standards within clinical governance and risk management may be achieved by focused practical training combined with formal written guidelines.
目前英国围手术期的液体和电解质管理可能并不理想。我们评估了外科顾问医生对液体和电解质处方的态度，并收集了关于改进该主题教育的建议。
向1091名大不列颠及爱尔兰外科医生协会会员发送了邮政问卷调查。在730份（67%）回复中，20份无效或不完整，对710份（65%）问卷进行了分析。结果指标包括为初级 staff 提供关于液体和电解质处方的指南和教学、液体管理的适当性以及改进标准的建议。
在22%的情况下，初级 staff 获得了书面指南。只有16%的受访者认为他们的预注册住院医生（PRHOs）在加入公司之前在该主题上接受了充分的培训；15%的人还表示，PRHOs在他们的公司没有接受太多培训。65%的人认为液体平衡表得到了准确维护，护理短缺是不准确的最常见原因。只有30%的人认为术后患者接受了适量的水、钠和钾。担任顾问超过5年的受访者比担任顾问5年的受访者更倾向于在液体补充不足的情况下犯错（63%对47%，P<0.0005）。改进教育的建议包括以问题为导向的病房查房、书面指南和患者病例讨论。
外科顾问医生认为目前围手术期液体管理的做法不尽人意。通过有针对性的实践培训与正式的书面指南相结合，可以在临床治理和风险管理方面实现更高的标准。
