目标导向液体治疗不能降低择期腹腔镜结直肠手术后的原发性术后肠梗阻：一项随机对照试验。

Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery: A Randomized Controlled Trial.

作者信息

Gómez-Izquierdo Juan C, Trainito Alessandro, Mirzakandov David, Stein Barry L, Liberman Sender, Charlebois Patrick, Pecorelli Nicolò, Feldman Liane S, Carli Franco, Baldini Gabriele

机构信息

From the Department of Anesthesia (J.C.G.-I., A.T., D.M., F.C., G.B.), Department of Surgery (B.L.S., A.S.L., P.C., N.P., L.S.F.), and Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery (N.P., L.S.F.), McGill University Health Centre, Montreal, Quebec, Canada.

出版信息

Anesthesiology. 2017 Jul;127(1):36-49. doi: 10.1097/ALN.0000000000001663.

DOI:10.1097/ALN.0000000000001663

PMID:28459732

Abstract

BACKGROUND

Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program.

METHODS

Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome.

RESULTS

One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different.

CONCLUSIONS

Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

摘要

背景

围手术期液体治疗不足会损害胃肠功能。主要评估目标导向液体治疗对原发性术后肠梗阻影响的研究尚缺。本研究的目的是确定在外科术后加速康复计划中，目标导向液体治疗是否能降低腹腔镜结直肠手术后原发性术后肠梗阻的发生率。

方法

在外科术后加速康复计划中，对接受腹腔镜结直肠手术的成年患者进行随机、患者及评估者双盲对照试验。患者被随机分配接受术中目标导向液体治疗（目标导向液体治疗组）或基于传统原则的液体治疗（对照组）。原发性术后肠梗阻是主要结局。

结果

纳入并分析了128例患者（目标导向液体治疗组：n = 64；对照组：n = 64）。目标导向液体治疗组原发性术后肠梗阻的发生率为22%，对照组为22%（相对危险度，1；95%可信区间，0.5至1.9；P = 1.00）。术中，目标导向液体治疗组患者接受的静脉液体较少（主要是晶体液较少），但胶体液量较多。目标导向液体治疗组每搏输出量和心输出量的增加更为显著且持续时间更长。住院时间、术后30天发病率和死亡率无差异。