Jacob Matthias, Chappell Daniel, Hollmann Markus W
Clinic of Anaesthesiology, Ludwig Maximilians University of Munich, Munich, Germany.
Curr Opin Anaesthesiol. 2009 Feb;22(1):100-8. doi: 10.1097/ACO.0b013e32831f1c65.
Perioperative fluid management influences patient outcome. Vascular surgery unites various surgical procedures, mainly with a high impact on patients who often have relevant preexisting illnesses. There are only scarce data on this specialty, forcing the clinician to extrapolate existing data when planning perioperative fluid management. This review aims to summarize the underlying facts.
Perioperative insensible perspiration does not exceed 1 ml/kg per hour. A third space shift does not exist; therefore, its primary substitution is erroneous. Rather, a crystalloid fluid excess causes a tremendous shift towards the interstitial space. Colloidal volume effects are context sensitive, that is, only their use as a substitute when blood or plasma loss occurs leads to maintenance within the circulatory space. Colloidal hypervolaemia and surgical trauma both have the potential to deteriorate the vascular barrier, leading to plasma loss into the interstitial space. Current perioperative fluid therapy should aim to maintain normovolaemia of the individual body fluid compartments as far as possible. This might be achieved by combining a protocol-based replacement of extracellular losses (urinary output plus insensible perspiration) with isotonic balanced crystalloids and blood volume optimization using isooncotic colloids.
The basis of fluid therapy in vascular surgery is a careful differential indication of the respective classes of preparations. A goal-directed approach might help to avoid hypovolaemia.
围手术期液体管理会影响患者预后。血管外科涵盖多种手术操作，对常伴有相关基础疾病的患者影响较大。关于这一专业的资料稀缺，这使得临床医生在规划围手术期液体管理时不得不推断现有数据。本综述旨在总结相关基本事实。
围手术期不显性失汗每小时不超过1毫升/千克。不存在第三间隙转移；因此，对其进行主要替代是错误的。相反，晶体液过量会导致大量液体转移至间质间隙。胶体液的容量效应取决于具体情况，也就是说，仅在发生失血或血浆丢失时将其用作替代品才能维持循环血容量。胶体液高血容量和手术创伤都有可能破坏血管屏障，导致血浆丢失至间质间隙。当前围手术期液体治疗应尽可能维持各体液腔室的正常血容量。这可以通过将基于方案的细胞外液丢失（尿量加不显性失汗）补充与等渗平衡晶体液相结合，并使用等容胶体液优化血容量来实现。
血管外科液体治疗的基础是对各类制剂进行仔细的鉴别使用。目标导向的方法可能有助于避免低血容量。
