Adesanya Adebola, Rosero Eric, Timaran Carlos, Clagett Patrick, Johnston William E
Department of Anesthesiology, University of Texas Southwestern Medical Center at Dallas, Dallas , USA.
Vasc Endovascular Surg. 2008;42(6):531-6. doi: 10.1177/1538574408318474. Epub 2008 Jun 25.
Traditional fluid resuscitation during general anesthesia has been questioned in recent studies. One study of patients undergoing abdominal surgery showed decreased postoperative weight gain, earlier return of bowel function, and shorter intensive care unit (ICU) and hospital length of stay (LOS) when intraoperative crystalloid infusion was restricted. The authors conducted a retrospective study of major vascular surgery patients (neo-aorto iliac system surgery) to correlate clinical outcomes with intraoperative crystalloid fluid administration.
The charts of 41 patients who underwent major vascular surgery at our institution were reviewed. Patients were grouped according to the crystalloid volume infused intraoperatively into <3 L (group 1) and >3 L (group 2). Preoperative and postoperative weights, intraoperative crystalloid administration, intraoperative vasopressor use, preoperative and postoperative creatinine, number of days to clear liquid diet, and the time to discharge from the ICU (ICU LOS) and hospital (hospital LOS) were collected.
There were statistically significant differences in duration of mechanical ventilation (0.55 +/- 0.934 vs 2.03 +/- 2.735 days, P = .013) and ICU LOS (3.0 +/- 1.48 vs 5.79 +/- 3.938, P = .029) in favor of the fluid restriction group. Major postoperative complications, such as sepsis, acute myocardial infarction, and graft thrombosis, were less frequent in the fluid restriction group but not statistically significant (5 vs 9, P = .742). Intraoperative crystalloid volume was found to be an independent predictor of ICU LOS after adjusting for estimated blood loss and duration of surgery. There was no statistically significant difference in preoperative serum albumin in both groups.
Restricted intraoperative administration of crystalloid fluids (<3 L) may be beneficial in major vascular surgery patients. These benefits are similar to those previously described in patients undergoing abdominal surgery.
近期研究对全身麻醉期间的传统液体复苏提出了质疑。一项针对接受腹部手术患者的研究表明，当术中晶体液输注受到限制时，术后体重增加减少、肠功能恢复更早，且重症监护病房（ICU）和住院时间（LOS）缩短。作者对接受大血管手术（新主动脉髂动脉系统手术）的患者进行了一项回顾性研究，以将临床结局与术中晶体液输注情况相关联。
回顾了在我们机构接受大血管手术的41例患者的病历。根据术中输注的晶体液量将患者分为<3L组（第1组）和>3L组（第2组）。收集术前和术后体重、术中晶体液输注量、术中血管升压药使用情况、术前和术后肌酐、清流质饮食天数以及从ICU出院时间（ICU LOS）和住院时间（住院LOS）。
液体限制组在机械通气时间（0.55±0.934天对2.03±2.735天，P = 0.013）和ICU LOS（3.0±1.48天对5.79±3.938天，P = 0.029）方面存在统计学显著差异，且有利于液体限制组。液体限制组术后严重并发症如败血症、急性心肌梗死和移植物血栓形成的发生率较低，但无统计学显著性差异（5例对9例，P = 0.742）。在调整估计失血量和手术持续时间后，发现术中晶体液量是ICU LOS的独立预测因素。两组术前血清白蛋白无统计学显著差异。
在大血管手术患者中，术中限制晶体液输注（<3L）可能有益。这些益处与先前在接受腹部手术患者中描述的益处相似。
