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新的围手术期液体与药物管理方案可减少失血、加快肠功能恢复及整体康复进程。

New perioperative fluid and pharmacologic management protocol results in reduced blood loss, faster return of bowel function, and overall recovery.

作者信息

Wuethrich Patrick Y, Burkhard Fiona C

机构信息

Department of Anaesthesiology and Pain Medicine, Bern University Hospital, CH-3010, Berne, Switzerland,

出版信息

Curr Urol Rep. 2015 Apr;16(4):17. doi: 10.1007/s11934-015-0490-1.

Abstract

Cystectomy and urinary diversion have high morbidity, and strategies to reduce complications are of utmost importance. Epidural analgesia and optimized fluid management are considered key factors contributing to successful enhanced recovery after surgery. In colorectal surgery, there is strong evidence that an intraoperative fluid management aiming for a postoperative zero fluid balance results in lower morbidity including a faster return of bowel function. Recently, a randomized clinical trial focusing on radical cystectomy demonstrated that a restrictive intraoperative hydration combined with a concomitant administration of norepinephrine reduced intraoperative blood loss, the need for blood transfusion and morbidity. The purpose of this review is to highlight specific anesthesiological aspects which have been shown to improve outcome after RC with urinary diversion.

摘要

膀胱切除术和尿流改道术具有较高的发病率,因此减少并发症的策略至关重要。硬膜外镇痛和优化的液体管理被认为是促进术后成功加速康复的关键因素。在结直肠手术中,有强有力的证据表明,以术后零液体平衡为目标的术中液体管理可降低发病率,包括肠道功能更快恢复。最近,一项针对根治性膀胱切除术的随机临床试验表明,限制性术中补液联合去甲肾上腺素给药可减少术中失血、输血需求和发病率。本综述的目的是强调已被证明可改善膀胱全切并尿流改道术后结局的特定麻醉学方面。

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