General Intensive Care Unit, Raymond Poincaré Hospital, GHU APHP University Paris-Saclay, Garches, France.
U1173 Laboratory of Inflammation and Infection, University of Versailles Saint-Quentin-en-Yvelines (UVSQ) and University Paris-Saclay - Institut National de la Santé et de la Recherche Médicale (INSERM), Montigny-le-Bretonneux, France.
Br J Surg. 2020 Jan;107(2):e56-e62. doi: 10.1002/bjs.11457.
Adequate fluid balance before, during and after surgery may reduce morbidity. This review examines current concepts surrounding fluid management in major elective surgery.
A narrative review was undertaken following a PubMed search for English language reports published before July 2019 using the terms 'surgery', 'fluids', 'fluid therapy', 'colloids', 'crystalloids', 'albumin', 'starch', 'saline', 'gelatin' and 'goal directed therapy'. Additional reports were identified by examining the reference lists of selected articles.
Fluid therapy is a cornerstone of the haemodynamic management of patients undergoing major elective surgery. Both fluid overload and hypovolaemia are deleterious during the perioperative phase. Zero-balance fluid therapy should be aimed for. In high-risk patients, individualized haemodynamic management should be titrated through the use of goal-directed therapy. The optimal type of fluid to be administered during major surgery remains to be determined.
Perioperative fluid management is a key challenge during major surgery. Individualized volume optimization by means of goal-directed therapy is warranted during high-risk surgery. In most patients, balanced crystalloids are the first choice of fluids to be used in the operating theatre. Additional research on the optimal type of fluid for use during major surgery is needed.
手术前后充足的液体平衡可能会降低发病率。本综述检查了在大型择期手术中液体管理的当前概念。
使用“手术”、“液体”、“液体治疗”、“胶体”、“晶体”、“白蛋白”、“淀粉”、“盐水”、“明胶”和“目标导向治疗”等术语，对 2019 年 7 月之前发表的英文报告进行了 PubMed 搜索，随后进行了叙述性综述。通过检查选定文章的参考文献列表，确定了其他报告。
液体治疗是行大型择期手术患者血流动力学管理的基石。围手术期液体过多和血容量不足都有害。应争取达到零平衡液体治疗。在高危患者中，应通过使用目标导向治疗来个体化血流动力学管理。在大型手术期间给予的最佳液体类型仍有待确定。
围手术期液体管理是大型手术期间的一个关键挑战。高危手术期间需要通过目标导向治疗进行个体化容量优化。在大多数患者中，平衡晶体是手术室中使用的首选液体。需要进一步研究大型手术中使用的最佳液体类型。
