Division of Colon & Rectal Surgery, State University of New York, Stony Brook, NY 11794-8191, USA.
Colorectal Dis. 2013 Jul;15(7):892-9. doi: 10.1111/codi.12180.
A randomized controlled trial was conducted to test the hypothesis that there is no difference in complications in patients receiving intravenous (iv) water and electrolyte, based on either stroke volume or clinical indicators at bowel surgery.
Eligible patients were randomized either to intra-operative iv administration of fluid boluses based on stroke volume measured by oesophageal Doppler (probe arm) or to iv fluid based on clinical indicators (no-probe arm). The end-point was the complication rate, defined as deviation from an uneventful postoperative course. Surgery was defined as elective bowel resection with primary anastomosis. All patients were on an enhanced recovery protocol. A randomized controlled trial suggested a sample size of 91 patients.
Ninety-one patients were randomized. Seventeen were excluded because of withdrawal of consent, failure of the procedure or cancellation of surgery. Patients were comparable for age (P = 0.89), gender (P = 0.14), body mass index (BMI) (P = 0.7), American Society of Anesthesiology (ASA) score (P > 0.9), race (P = 0.55), colorectal POSSUM score (P = 0.11), comorbidity (P = 0.4), previous operations (P = 0.45) and diagnosis (P = 0.50). Physiological and Operative Severity Score for the Enumeration of Morbidity and Mortality (POSSUM)-predicted mortality was higher in the test (probe) arm (P = 0.011). No differences were observed in epidural analgesia (P = 0.16), type of resection (P = 0.43), incision length (P = 0.40), type of incision (P = 0.47), operation time (P = 0.92), estimated blood loss (EBL) (P = 0.56), time to ambulation (P = 0.95), flatus (P = 0.37), diet (P = 0.17), removal of the epidural anaesthesia (P = 0.26) and length of hospital stay (LOS) (P = 0.575). Intra-operative fluids administered were 3.1 (0.7-77) vs 4 (0.9-6.2) liters (P = 0.53). Postoperative fluids administered were 12.5 (5.5-84.6) vs 11.3 (3.4-49.8) (P = 0.42). Overall and septic complication rates were significantly decreased in the test arm (7/32 (22%) vs 19/40 (49%) (P = 0.022) and 2/32 (6.2%) vs 12/40 (30%) (P = 0.05), respectively).
Intra-operative administration of iv water and electrolyte during bowel surgery, based on stroke volume measured using oesophageal Doppler, was associated with decreased complication rates.
一项随机对照试验旨在检验以下假设，即在接受静脉（iv）水和电解质治疗的患者中，根据术中测量的每搏量或临床指标，不会出现并发症的差异。
符合条件的患者随机分配到基于食管多普勒测量的每搏量（探头臂）的术中静脉补液，或基于临床指标（无探头臂）的静脉补液。终点是并发症发生率，定义为术后无并发症的过程偏离。手术定义为择期肠切除术加一期吻合术。所有患者均采用强化康复方案。一项随机对照试验建议样本量为 91 例。
91 例患者被随机分配。由于退出同意、手术失败或手术取消，17 例被排除在外。患者的年龄（P=0.89）、性别（P=0.14）、体重指数（BMI）（P=0.7）、美国麻醉医师协会（ASA）评分（P＞0.9）、种族（P=0.55）、结直肠 POSSUM 评分（P=0.11）、合并症（P=0.4）、既往手术（P=0.45）和诊断（P=0.50）均具有可比性。生理学和手术严重程度评分用于评估发病率和死亡率（POSSUM）的预测死亡率在试验（探头）臂中更高（P=0.011）。硬膜外镇痛（P=0.16）、切除术类型（P=0.43）、切口长度（P=0.40）、切口类型（P=0.47）、手术时间（P=0.92）、估计失血量（EBL）（P=0.56）、下床时间（P=0.95）、排气（P=0.37）、饮食（P=0.17）、硬膜外麻醉的去除（P=0.26）和住院时间（LOS）（P=0.575）无差异。术中给予的液体分别为 3.1（0.7-77）和 4（0.9-6.2）升（P=0.53）。术后给予的液体分别为 12.5（5.5-84.6）和 11.3（3.4-49.8）（P=0.42）。试验臂的总体和脓毒症并发症发生率显著降低（7/32（22%）比 19/40（49%）（P=0.022）和 2/32（6.2%）比 12/40（30%）（P=0.05））。
在接受肠手术的患者中，根据食管多普勒测量的每搏量，术中给予静脉水和电解质，可降低并发症发生率。
