Miller Timothy E, Pearse Rupert M
1Duke University School of Medicine, Durham, NC USA.
2Queen Mary University of London, London, UK.
Perioper Med (Lond). 2019 Jul 15;8:2. doi: 10.1186/s13741-019-0113-3. eCollection 2019.
Perioperative fluid and hemodynamic management have been much-debated topics over the last few years. Recently, a number of large trials have been published to help inform this debate. The Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) study is the largest trial to date of perioperative fluid management. The 3000-patient trial comparing 2 different fluid regimes showed that a restrictive fluid regimen during and up to 24 h after surgery was associated with an increase in acute kidney injury (AKI). This result is at odds with a recent trend to a more restrictive fluid approach during major surgery and suggests that practice may have become too restrictive. A moderately liberal (aiming for 1-2 l positive) or goal-directed approach is therefore recommended.
在过去几年中，围手术期液体和血流动力学管理一直是备受争议的话题。最近，一些大型试验已发表，以助于为这场辩论提供信息。腹部大手术的限制性与开放性液体疗法（RELIEF）研究是迄今为止围手术期液体管理方面规模最大的试验。这项有3000名患者参与的试验比较了两种不同的液体方案，结果显示，手术期间及术后24小时内采用限制性液体方案与急性肾损伤（AKI）增加有关。这一结果与近期在大手术中采用更严格液体管理方法的趋势相悖，表明实际操作可能过于严格。因此，建议采用适度开放（目标为1-2升正平衡）或目标导向的方法。
