Faculty of Medicine, Cairo University, Cairo, Egypt.
NCI (National Cancer Institute), Cairo University, Cairo, Egypt.
Anaesthesiol Intensive Ther. 2021;53(4):296-303. doi: 10.5114/ait.2021.105771.
Goal-directed fluid therapy (GDT) aims to increase stroke volume and cardiac output and improve gut perfusion. Hypertonic saline (HS) can restore the macro-and micro-circulation, increase myocardial contractility, and reduce tissue edema. Therefore, we aimed to investigate the efficacy of intraoperative HS administration in GDT during gastrointestinal (GI) surgery.
Forty patients who underwent GI surgery under general anesthesia were enrolled in this randomized controlled study. Patients received boluses of either lactated Ringer's (LR) solution, or 3% HS solution guided by an algorithm dependent on a smartphone application for estimations of pulse pressure variation (PPV). The primary outcome was the total amount of administered intraoperative crystalloid fluids in both groups. Serum sodium and time to first bowel movement after surgery were also recorded.
In the HS group, patients received 1262.50 ± 318.25 mL of crystalloids compared to 2667.50 ± 670.29 mL received by patients in the LR group (P 0.05.
The use of HS solution for GDT in GI surgery resulted in a beneficial reduction in positive fluid balance and possibly earlier resumption of bowel movements.
目标导向液体治疗（GDT）旨在增加每搏输出量和心输出量，改善肠道灌注。高渗盐水（HS）可恢复宏观和微循环，增加心肌收缩力，减少组织水肿。因此，我们旨在研究胃肠道（GI）手术中 GDT 期间术中给予 HS 的疗效。
本随机对照研究纳入了 40 名在全身麻醉下接受 GI 手术的患者。患者根据智能手机应用程序算法接受乳酸林格氏液（LR）或 3% HS 溶液的推注，该算法依赖于智能手机应用程序来估计脉压变化（PPV）。主要结局是两组患者术中晶体液的总用量。还记录了血清钠浓度和术后首次排便时间。
HS 组患者接受了 1262.50±318.25ml 的晶体液，而 LR 组患者接受了 2667.50±670.29ml（P<0.05）。两组间的其他观察结果无统计学差异。两组患者术后的血清钠浓度无显著差异（P>0.05）。HS 组患者术后首次排便时间较早（P<0.05）。
在 GI 手术中，使用 HS 溶液进行 GDT 可带来有益的正液体平衡减少，并且可能更早恢复肠蠕动。
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