Gill Preetjote, Chua Terence C, Huang Yeqian, Mehta Shreya, Mittal Anubhav, Gill Anthony J, Samra Jaswinder S
Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2018 Apr;88(4):E318-E323. doi: 10.1111/ans.13913. Epub 2017 Feb 27.
The dogma of administering sufficient intravenous fluids aggressively to avoid under-resuscitation has recently been challenged. Evidence suggests that excessive perioperative fluid administration may be associated with negative clinical outcomes in gastrointestinal surgery. This study examines the impact of fluid administration on perioperative outcomes in patients undergoing pancreatoduodenectomy (PD).
A retrospective analysis of 202 patients undergoing PD between January 2004 and August 2015 was performed. A cut-off value of 10 mL/kg/h was applied (low fluid group: <10 mL/kg/h versus high fluid group: ≥10 mL/kg/h).
There were 76 patients in the low fluid group and 126 patients in the high fluid group. Both groups had comparable age, American Society of Anesthesiologists score and preoperative morbidity rates. Patients in the high fluid group received significantly more total fluids, crystalloids and colloids intraoperatively (P < 0.0001, P < 0.0001 and P = 0.013, respectively) without a significant difference in estimated blood loss (P = 0.586). The net fluid balance on post-operative day 0 was also significantly higher in the high fluid group (P < 0.0001). The mortality rate was 0% in the cohort. Major morbidity rate was 46.1% and 44.4% in low and high fluid groups, respectively (P = 0.836). Reoperation rate was 5.3% for the low fluid group and 1.6% for the high fluid group (P = 0.136). There were no significant differences between the groups for any of the individual complications.
This study did not identify a difference in post-operative outcomes between the low and high fluid regime in patients undergoing PD.
积极给予充足静脉输液以避免复苏不足的教条最近受到了挑战。有证据表明，围手术期过量输液可能与胃肠手术的不良临床结局相关。本研究探讨了输液对接受胰十二指肠切除术（PD）患者围手术期结局的影响。
对2004年1月至2015年8月期间接受PD的202例患者进行回顾性分析。采用10毫升/千克/小时的临界值（低输液组：<10毫升/千克/小时，高输液组：≥10毫升/千克/小时）。
低输液组有76例患者，高输液组有126例患者。两组在年龄、美国麻醉医师协会评分和术前发病率方面具有可比性。高输液组患者术中接受的总液体量、晶体液量和胶体液量明显更多（分别为P < 0.0001、P < 0.0001和P = 0.013），但估计失血量无显著差异（P = 0.586）。高输液组术后第0天的净液体平衡也明显更高（P < 0.0001）。该队列的死亡率为0%。低输液组和高输液组的主要发病率分别为46.1%和44.4%（P = 0.836）。低输液组的再次手术率为5.3%，高输液组为1.6%（P = 0.136）。两组在任何个体并发症方面均无显著差异。
本研究未发现接受PD的患者在低输液方案和高输液方案之间的术后结局存在差异。
