围手术期补充液体可提高组织氧分压。

Supplemental perioperative fluid administration increases tissue oxygen pressure.

作者信息

Arkiliç Cem F, Taguchi Akiko, Sharma Neeru, Ratnaraj Jebadurai, Sessler Daniel I, Read Thomas E, Fleshman James W, Kurz Andrea

机构信息

Department of Anesthesiology, Section of Colon and Rectal Surgery, Washington University, St Louis, Mo, USA.

出版信息

Surgery. 2003 Jan;133(1):49-55. doi: 10.1067/msy.2003.80.

DOI:10.1067/msy.2003.80

PMID:12563237

Abstract

BACKGROUND

Wound infections are common and serious surgical complications. Wound perfusion delivers oxygen, inflammatory cells, growth factors, and cytokines to injured tissues. Hypoperfused regions experience low oxygen tensions that do not support adequate oxidative killing or wound healing. Clinicians may fail to recognize clinically important hypovolemia because hemodynamic stability and urine output are maintained after peripheral perfusion is compromised. We tested the hypothesis that supplemental fluid administration during and after elective colon resection increases tissue perfusion and tissue oxygen pressure.

METHODS

Fifty-six patients undergoing colon resection were randomly assigned to conservative (8 mL x kg(-1) x h(-1), n = 26) or aggressive (16 to 18 mL x kg(-1) x h(-1), n = 30) fluid management. Anesthetic technique was standardized. We used 60% nitrous oxide in 40% oxygen. During surgery and postanesthetic recovery, subcutaneous oxygen tension (P(sq)O(2)) was measured by using a polarographic sensor implanted subcutaneously into 1 upper arm. Capillary blood flow was evaluated postoperatively with a thermal diffusion system. Data were analyzed with 2-tailed t tests; P value less than.05 was considered statistically significant.

RESULTS

Hemodynamic and renal responses were similar in the groups. Intraoperative tissue oxygen tension was significantly greater in patients given supplemental fluid: 81 +/- 26 vs 67 +/- 18 mm Hg, P =.03. Postoperative P(sq)O(2) (77 +/- 26 vs 59 +/- 15 mm Hg, P =.009) and capillary blood flow (69 +/- 12 vs 53 +/- 12, P <.001) were also greater in the supplemental fluid patients.

CONCLUSIONS

Supplemental perioperative fluid administration significantly increases tissue perfusion and tissue oxygen partial pressure. Optimizing tissue perfusion will require providing more fluid than indicated by normal clinical criteria or use of invasive monitoring to guide treatment. The actual effect of supplemental fluid administration on incidence of wound infection requires further investigation.

摘要

背景

伤口感染是常见且严重的手术并发症。伤口灌注可将氧气、炎性细胞、生长因子和细胞因子输送至受伤组织。灌注不足的区域氧分压较低，无法支持充分的氧化杀伤或伤口愈合。临床医生可能无法识别具有临床意义的血容量不足，因为在周围灌注受损后血流动力学稳定性和尿量仍可维持。我们检验了以下假设：在择期结肠切除术中及术后补充液体可增加组织灌注和组织氧分压。

方法

56例行结肠切除术的患者被随机分配至保守（8 mL×kg⁻¹×h⁻¹，n = 26）或积极（16至18 mL×kg⁻¹×h⁻¹，n = 30）液体管理组。麻醉技术标准化。我们使用60%氧化亚氮和40%氧气。在手术期间及麻醉后恢复期间，使用皮下植入上臂的极谱传感器测量皮下氧分压（P(sq)O₂）。术后用热扩散系统评估毛细血管血流。数据采用双侧t检验进行分析；P值小于0.05被认为具有统计学意义。