Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
J Surg Res. 2012 Mar;173(1):68-74. doi: 10.1016/j.jss.2010.08.051. Epub 2010 Sep 27.
Key factors of Fast Track (FT) programs are fluid restriction and epidural analgesia (EDA). We aimed to challenge the preconception that the combination of fluid restriction and EDA might induce hypotension and renal dysfunction.
A recent randomized trial (NCT00556790) showed reduced complications after colectomy in FT patients compared with standard care (SC). Patients with an effective EDA were compared with regard to hemodynamics and renal function.
61/76 FT patients and 59/75 patients in the SC group had an effective EDA. Both groups were comparable regarding demographics and surgery-related characteristics. FT patients received significantly less i.v. fluids intraoperatively (1900 mL [range 1100-4100] versus 2900 mL [1600-5900], P < 0.0001) and postoperatively (700 mL [400-1500] versus 2300 mL [1800-3800], P < 0.0001). Intraoperatively, 30 FT compared with 19 SC patients needed colloids or vasopressors, but this was statistically not significant (P = 0.066). Postoperative requirements were low in both groups (3 versus 5 patients; P = 0.487). Pre- and postoperative values for creatinine, hematocrit, sodium, and potassium were similar, and no patient developed renal dysfunction in either group. Only one of 82 patients having an EDA without a bladder catheter had urinary retention. Overall, FT patients had fewer postoperative complications (6 versus 20 patients; P = 0.002) and a shorter median hospital stay (5 [2-30] versus 9 d [6-30]; P< 0.0001) compared with the SC group.
Fluid restriction and EDA in FT programs are not associated with clinically relevant hemodynamic instability or renal dysfunction.
快速通道（FT）方案的关键因素是液体限制和硬膜外镇痛（EDA）。我们旨在挑战这样一种观念，即液体限制和 EDA 的联合应用可能会导致低血压和肾功能障碍。
最近一项随机试验（NCT00556790）显示，与标准护理（SC）相比，FT 患者在结肠切除术后并发症减少。对接受有效 EDA 的患者进行了血流动力学和肾功能比较。
FT 组 76 例患者中有 61 例和 SC 组 75 例患者中有 59 例接受了有效 EDA。两组在人口统计学和手术相关特征方面具有可比性。FT 患者术中接受的静脉输液量明显减少（1900 mL [范围 1100-4100] 与 2900 mL [1600-5900]，P < 0.0001）和术后（700 mL [400-1500] 与 2300 mL [1800-3800]，P < 0.0001）。术中，与 SC 组相比，30 例 FT 患者需要胶体或血管加压药，尽管这在统计学上无显著性差异（P = 0.066）。两组术后的需求都很低（3 例与 5 例；P = 0.487）。术前和术后肌酐、血细胞比容、钠和钾的值相似，两组均无患者发生肾功能障碍。在 82 例接受 EDA 而未留置导尿管的患者中，仅有 1 例发生尿潴留。总体而言，FT 患者术后并发症较少（6 例与 20 例；P = 0.002），中位住院时间较短（5 [2-30] 与 9 d [6-30]；P< 0.0001）与 SC 组相比。
FT 方案中的液体限制和 EDA 与临床相关的血流动力学不稳定或肾功能障碍无关。
