Yao Lei, Wang Yulan, Du Boxiang, Song Jie, Ji Fuhai
*Department of Anesthesiology, The Second Affiliated Hospital of Nantong University, Nantong †Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Surg Laparosc Endosc Percutan Tech. 2017 Oct;27(5):346-350. doi: 10.1097/SLE.0000000000000463.
Different fluid regimens are used in the clinical management of perioperative fluid therapy, but there still is the argument about which fluid regimen is better for patients. This study was mainly designed to compare different fluid regimens on postoperative pain and residual gas in patients undergoing laparoscopic cholecystectomy.
A total of 100 patients were equally randomized to receive restrictive fluid infusion (n=50) with lactated Ringer (LR) solution 5 mL/kg/h or liberal fluid infusion (n=50), with 30 mL/kg/h lactated Ringer solution. Postoperative pain was evaluated at 1, 6, and 24 hours after surgery using a visual analog scale (VAS). Postoperative subdiaphragmatic residual gas was monitored by x-ray at 24 hours after surgery.
Patients in the restrictive group had significantly higher VAS pain scores at 6 hours after surgery than those in the liberal group (P=0.009). The incidence of subdiaphragmatic residual gas in the restrictive group was higher than in the liberal group (P=0.045). Patients who had residual gas had higher VAS pain scores than those with no residual gas in the restrictive group at 6 hours after surgery (P=0.02).
Patients undergoing laparoscopic cholecystectomy with restrictive fluid therapy may suffer more severe postoperative pain than those receiving liberal fluid therapy. It suggests that the higher incidence of subdiaphragmatic residual gas may have occurred with restrictive fluid therapy.
围手术期液体治疗的临床管理中使用了不同的液体方案，但对于哪种液体方案对患者更有利仍存在争议。本研究主要旨在比较不同液体方案对腹腔镜胆囊切除术患者术后疼痛和残余气体的影响。
总共100例患者被平均随机分为两组，分别接受限制性液体输注（n = 50），即乳酸林格氏液（LR）5 mL/kg/h，或自由液体输注（n = 50），即乳酸林格氏液30 mL/kg/h。术后1、6和24小时使用视觉模拟评分法（VAS）评估疼痛情况。术后24小时通过X线监测膈下残余气体。
限制性组患者术后6小时的VAS疼痛评分显著高于自由组（P = 0.009）。限制性组膈下残余气体的发生率高于自由组（P = 0.045）。在限制性组中，术后6小时有残余气体的患者VAS疼痛评分高于无残余气体的患者（P = 0.02）。
接受限制性液体治疗的腹腔镜胆囊切除术患者术后疼痛可能比接受自由液体治疗的患者更严重。这表明限制性液体治疗可能导致膈下残余气体发生率更高。
