Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
J Am Coll Surg. 2013 Jun;216(6):1124-34. doi: 10.1016/j.jamcollsurg.2013.02.011. Epub 2013 Apr 23.
Intrathecal analgesia and avoidance of perioperative fluid overload are key items within enhanced recovery pathways. Potential side effects include hypotension and renal dysfunction.
From January 2010 until May 2010, all patients undergoing colorectal surgery within enhanced recovery pathways were included in this retrospective cohort study and were analyzed by intrathecal analgesia (IT) vs none (noIT). Primary outcomes measures were systolic and diastolic blood pressure, mean arterial pressure, and heart rate for 48 hours after surgery. Renal function was assessed by urine output and creatinine values.
One hundred and sixty-three consecutive colorectal patients (127 IT and 36 noIT) were included in the analysis. Both patient groups showed low blood pressure values within the first 4 to 12 hours and a steady increase thereafter before return to baseline values after about 24 hours. Systolic and diastolic blood pressure and mean arterial pressure were significantly lower until 16 hours after surgery in patients having IT compared with the noIT group. Low urine output (<0.5 mL/kg/h) was reported in 11% vs 29% (IT vs noIT; p = 0.010) intraoperatively, 20% vs 11% (p = 0.387), 33% vs 22% (p = 0.304), and 31% vs 21% (p = 0.478) for postanesthesia care unit and postoperative days 1 and 2, respectively. Only 3 of 127 (2.4%) IT and 1 of 36 (2.8%) noIT patients had a transitory creatinine increase >50%; no patients required dialysis.
Postoperative hypotension affects approximately 10% of patients within an enhanced recovery pathway and is slightly more pronounced in patients with IT. Hemodynamic depression persists for <20 hours after surgery; it has no measurable negative impact and therefore cannot justify detrimental postoperative fluid overload.
鞘内镇痛和避免围手术期液体超负荷是加速康复途径中的关键项目。潜在的副作用包括低血压和肾功能障碍。
从 2010 年 1 月到 2010 年 5 月，所有在加速康复途径中接受结直肠手术的患者均被纳入本回顾性队列研究，并通过鞘内镇痛（IT）与非 IT 进行分析。主要结局指标为术后 48 小时内的收缩压和舒张压、平均动脉压和心率。肾功能通过尿量和肌酐值来评估。
共有 163 例连续的结直肠患者（127 例 IT 和 36 例非 IT）被纳入分析。两组患者在前 4 至 12 小时内血压值均较低，此后逐渐升高，约 24 小时后恢复至基线值。与非 IT 组相比，IT 组患者在术后至 16 小时的收缩压、舒张压和平均动脉压均显著降低。术中报告低尿量（<0.5ml/kg/h）的患者分别为 11%和 29%（IT 和非 IT；p=0.010）、20%和 11%（p=0.387）、33%和 22%（p=0.304）、31%和 21%（p=0.478）在麻醉后监护病房和术后第 1、2 天。仅 3 例（2.4%）IT 患者和 1 例（2.8%）非 IT 患者出现肌酐升高>50%的一过性增加；无患者需要透析。
在加速康复途径中，约有 10%的患者发生术后低血压，而接受 IT 的患者则更为明显。术后 20 小时内血流动力学抑制持续存在；它没有可衡量的负面影响，因此不能证明术后过度补液是合理的。
