术前液体潴留会增加大型开放性腹部手术期间的失血量。

Preoperative fluid retention increases blood loss during major open abdominal surgery.

作者信息

Hahn Robert G, Bahlmann Hans, Nilsson Lena

机构信息

Research Unit, Södertälje Hospital, SE-152 86 Södertälje, Sweden.

Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden.

出版信息

Perioper Med (Lond). 2017 Sep 2;6:12. doi: 10.1186/s13741-017-0068-1. eCollection 2017.

DOI:10.1186/s13741-017-0068-1

PMID:28878889

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5581451/

Abstract

BACKGROUND

Quantification of renal fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this fluid retention correlates with fluid requirements during major abdominal surgeries that have estimated operating times ≥ 2 h.

METHODS

Urine colour, specific weight, osmolality and creatinine concentration were used to calculate a composite "fluid retention index" (FRI) in 97 patients prior to major abdominal surgery. Goal-directed fluid volume optimization, with hydroxyethyl starch supplemented with a background administration of crystalloid fluid, was used.

RESULTS

The median preoperative FRI was 3.0. Fluid retention, considered as present when FRI ≥ 3.5, was found in 37% of the patients. Fluid retention was followed by a significantly larger blood loss (+ 125%; 450 vs. 200 ml), higher haemorrhage rate (+ 41%; 123 vs. 87 ml/h) and greater need for both colloid (+ 43%; 1.43 vs. 1.00 l) and crystalloid (+ 18%; 1.28 vs. 1.08 l) fluids. Despite the larger blood loss, the total fluid balance was more positive after surgery in the dehydrated patients (+ 26%; 1.91 vs. 1.51 l; < 0.02).

CONCLUSIONS

Preoperative fluid retention, as detected in a urine sample, was associated with a greater blood loss and a more positive fluid balance during major abdominal surgery.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01458678.

摘要

背景

通过尿液分析可以对肾脏的液体潴留情况进行量化，其结果能够提示脱水情况。本报告旨在确定这种液体潴留是否与预计手术时间≥2小时的大型腹部手术期间的液体需求量相关。

方法

在97例大型腹部手术患者术前，采用尿液颜色、比重、渗透压和肌酐浓度来计算综合“液体潴留指数”（FRI）。采用目标导向的液体量优化方案，以羟乙基淀粉补充晶体液作为背景输注。

结果

术前FRI中位数为3.0。当FRI≥3.5时判定为存在液体潴留，37%的患者存在该情况。出现液体潴留的患者随后出现明显更多的失血量（增加125%；450 vs. 200 ml）、更高的出血率（增加41%；123 vs. 87 ml/h）以及对胶体液（增加43%；1.43 vs. 1.00 l）和晶体液（增加18%；1.28 vs. 1.08 l）的更大需求。尽管失血量更多，但脱水患者术后的总液体平衡更为正向（增加26%；1.91 vs. 1.51 l；P<0.02）。