Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Br J Surg. 2012 Feb;99(2):186-91. doi: 10.1002/bjs.7702. Epub 2011 Sep 21.
Perioperative fluid therapy can influence postoperative hospital stay and complications after elective colorectal surgery. This trial was designed to examine whether an extremely restricted perioperative fluid protocol would reduce hospital stay beyond the existing fast-track hospital time of 7 days after surgery.
Patients were randomized to restricted or standard perioperative intravenous fluid regimens in a single-centre trial. Randomization was stratified for colonic, rectal, open and laparoscopic surgery. Patients were all treated within a fast-track protocol (careful preoperative preparation, optimal analgesia, early oral nutrition and early mobilization). The primary endpoint was length of postoperative hospital stay. The secondary endpoint was complications within 30 days.
Seventy-nine patients were randomized to restricted and 82 to standard fluid therapy. Patients in the restricted group received a median of 3050 ml fluid on the day of surgery compared with 5775 ml in the standard group (P < 0·001). There was no difference between groups in primary hospital stay (median 6·0 days in both groups; P = 0·194) or stay including readmission (median 6·0 days in both groups; P = 0·158). The proportion of patients with complications was significantly lower in the restricted group (31 of 79 versus 47 of 82; P = 0·027). Vasopressors were more often required in the restricted group (97 versus 80 per cent; P < 0·001).
Restricted perioperative intravenous fluid administration does not reduce length of stay in a fast-track protocol.
围手术期液体治疗可能会影响择期结直肠手术后的住院时间和并发症。本试验旨在研究极度限制围手术期液体方案是否会缩短术后住院时间，超过现有快速通道手术后 7 天的时间。
在一项单中心试验中，患者被随机分配到限制或标准围手术期静脉液体方案中。随机化按结肠、直肠、开放和腹腔镜手术进行分层。所有患者均接受快速通道方案治疗（术前精心准备、最佳镇痛、早期口服营养和早期活动）。主要终点是术后住院时间。次要终点是 30 天内的并发症。
79 例患者被随机分配到限制组和 82 例标准组接受液体治疗。限制组患者在手术当天接受的中位液体量为 3050 毫升，而标准组为 5775 毫升（P < 0·001）。两组患者的主要住院时间（两组中位数均为 6·0 天；P = 0·194）或包括再入院在内的住院时间（两组中位数均为 6·0 天；P = 0·158）均无差异。限制组患者并发症比例显著降低（31/79 例比 47/82 例；P = 0·027）。限制组需要血管加压药的患者比例更高（97%比 80%；P < 0·001）。
限制围手术期静脉输液并不能缩短快速通道方案的住院时间。
