Zhu Alyssa Cheng-Cheng, Agarwala Aalok, Bao Xiaodong
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Clin Colon Rectal Surg. 2019 Mar;32(2):114-120. doi: 10.1055/s-0038-1676476. Epub 2019 Feb 28.
Fluid management is an essential component of the Enhanced Recovery after Surgery (ERAS) pathway. Optimal management begins in the preoperative period and continues through the intraoperative and postoperative phases. In this review, we outline current evidence-based practices for fluid management through each phase of the perioperative period. Preoperatively, patients should be encouraged to hydrate until 2 hours prior to the induction of anesthesia with a carbohydrate-containing clear liquid. When mechanical bowel preparation is necessary, with modern isoosmotic solutions, fluid repletion is not necessary. Intraoperatively, fluid therapy should aim to maintain euvolemia with an individualized approach. While some patients may benefit from goal-directed fluid therapy, a restrictive, zero-balance approach to intraoperative fluid management may be reasonable. Postoperatively, early initiation of oral intake and cessation of intravenous therapy are recommended.
液体管理是术后加速康复（ERAS）路径的重要组成部分。最佳管理始于术前阶段，并贯穿术中及术后阶段。在本综述中，我们概述了围手术期各阶段液体管理的当前循证实践。术前，应鼓励患者在麻醉诱导前2小时饮用含碳水化合物的清亮液体进行水合。当需要进行机械肠道准备时，使用现代等渗溶液则无需补充液体。术中，液体治疗应以个体化方法维持血容量正常为目标。虽然一些患者可能从目标导向液体治疗中获益，但术中液体管理采用限制性零平衡方法可能是合理的。术后，建议尽早开始口服摄入并停止静脉治疗。
