Bonasso Patrick C, Lucke-Wold Brandon, Hobbs Gerald R, Vaughan Richard A, Shorter Nicholas A, Nakayama Don K
Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Am Surg. 2016 Aug;82(8):704-6.
Careful fluid management is a cornerstone of neonatology because the cardiovascular, respiratory, and gastrointestinal systems in the newborn are sensitive to overhydration. Fluid management in gastroschisis is complicated by insensible fluid loss and postoperative third-space fluid shifts. Study of perioperative fluid management in gastroschisis is limited and has not undergone careful scrutiny. We reviewed perioperative fluid administration and urine output in all infants with gastroschisis over a 5-year period. Data included whether the patient underwent primary closure or staged repair, weight, and events during hospitalization (length of hospitalization and duration of gastric decompression, parenteral nutrition, and ventilator support). Paired t test gave statistical comparisons with significance at P < 0.05. From 2010 to 2014, 24 patients underwent abdominal closure, 17 had primary and 7 had staged closures. Fluid administration exceeded 100 mL/kg/d after primary closure, and was significantly higher (>150 mL/kg/d; P < 0.05) after staged closure on postoperative days 0 to 5. Postoperative urinary output exceeded 75 mL/kg/d for all patients, with higher volumes reaching 100 mL/kg/d after staged closure on postoperative days 4 to 6 (P < 0.05). Two patients died of sepsis. All survivors were discharged with intestinal continuity and gaining weight on oral feeding. Patients with gastroschisis received large volumes of fluid after operation despite similarly high urine output and positive daily fluid balances. The amounts of fluid administered after both primary and staged closure may be excessive and potentially deleterious.
谨慎的液体管理是新生儿学的基石，因为新生儿的心血管、呼吸和胃肠道系统对液体摄入过多很敏感。腹裂患儿的液体管理因不显性失水和术后第三间隙液体转移而变得复杂。关于腹裂围手术期液体管理的研究有限，且尚未经过仔细审查。我们回顾了5年间所有腹裂患儿的围手术期液体输注量和尿量。数据包括患者是否接受一期缝合或分期修复、体重以及住院期间的情况（住院时间、胃肠减压时间、肠外营养时间和机械通气支持时间）。配对t检验进行统计学比较，P<0.05时有显著性差异。2010年至2014年，24例患者接受了腹部闭合手术，其中17例行一期缝合，7例行分期缝合。一期缝合后液体输注量超过100 mL/（kg·d），术后第0至5天分期缝合后的液体输注量显著更高（>150 mL/（kg·d）；P<0.05）。所有患者术后尿量均超过75 mL/（kg·d），分期缝合术后第4至6天尿量更高，可达100 mL/（kg·d）（P<0.05）。2例患者死于败血症。所有存活患者出院时肠道功能恢复且经口喂养体重增加。尽管腹裂患儿术后尿量同样很高且每日液体平衡为正，但术后仍接受了大量液体输注。一期缝合和分期缝合后输注的液体量可能过多且有潜在危害。
