[术中液体治疗对“快速康复”结肠手术术后结局的影响]
[The influence of intraoperative fluid therapy on the postoperative outcome in "fast track" colon surgery].
作者信息
von Heymann C, Grebe D, Schwenk W, Sander M, Hensel M, Müller J M, Spies C
机构信息
Klinik für Anästhesiologie und operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin.
出版信息
Anasthesiol Intensivmed Notfallmed Schmerzther. 2006 Jun;41(6):E1-7. doi: 10.1055/s-2006-944529.
OBJECTIVE
To evaluate the association between the intraoperative and postoperative application of different quantities of fluids and the incidence of postoperative complications after "fast-track"-colonic surgery.
METHODS
We performed a retrospective analysis of 136 patients undergoing elective "fast-track" colonic surgery (sigma resection and right hemicolectomy). Data collection in regard of fluid administration during surgery and in the post anaesthesia care unit (PACU) was based on anaesthesia charts and a prospectively generated surgery database. Classification into three volume groups (up to 3500 ml = group 1, 3500 - 5500 ml = group 2, more than 5500 ml = group 3). Basic patient characteristics, pre-existing conditions, type and duration of surgery and anastomoses were documented. We analysed the incidence of postoperative complications such as wound infections, anastomotic leak, bleeding, bowel obstruction, cardiovascular failure, hypertension, pulmonary failure, pneumonia, renal failure, urinary tract infection, neurological and psychiatric complications in the different volume groups.
RESULTS
115 patients were infused with up to 3500 mLs of fluids, 19 patients received more than 3500 mLs, two patients were infused with 6000 ml and 7500 mLs, respectively. This was in median 36 ml/kg in the restrictive and 53 ml/kg in the higher volume groups (group 2 and 3 together), respectively. The duration of surgery and anaesthesia was significantly different between both fluid groups (p = 0,023). In a logistic regression model only intraoperative blood loss was independently associated with the volume of infused fluid (OR 0,393, 95 % CI 1.028 - 2.306, p < 0.01). The rate of postoperative complications was not different between groups (p = 0,228).
CONCLUSION
The incidence of postoperative complications was not different between patients who were infused 36 ml/kg or 53 ml/kg of fluids during surgery and post anaesthesia care unit stay.
目的
评估“快速康复”结肠手术中及术后不同补液量与术后并发症发生率之间的关联。
方法
我们对136例行择期“快速康复”结肠手术（乙状结肠切除术和右半结肠切除术）的患者进行了回顾性分析。基于麻醉记录单和前瞻性建立的手术数据库收集手术期间及麻醉后监护病房（PACU）的补液数据。分为三个补液量组（≤3500 ml = 第1组，3500 - 5500 ml = 第2组，＞5500 ml = 第3组）。记录患者基本特征、基础疾病情况、手术类型及持续时间和吻合情况。我们分析了不同补液量组术后并发症的发生率，如伤口感染、吻合口漏、出血、肠梗阻、心血管衰竭、高血压、肺衰竭、肺炎、肾衰竭、尿路感染、神经及精神并发症。
结果
115例患者补液量≤3500 mL，19例患者补液量＞3500 mL，2例患者分别补液6000 ml和7500 mL。限制补液量组中位数为36 ml/kg，高补液量组（第2组和第3组合并）中位数为53 ml/kg。两组补液量组间手术及麻醉持续时间有显著差异（p = 0.023）。在逻辑回归模型中，仅术中失血量与补液量独立相关（OR 0.393，95%CI 1.028 - 2.306，p ＜ 0.01）。各组间术后并发症发生率无差异（p = 0.228）。
结论
手术及麻醉后监护病房期间补液量为36 ml/kg或53 ml/kg的患者术后并发症发生率无差异。
Zotero 插件