Elsonbaty Mohamed, Abdullah Sherif, Elsonbaty Ahmed
Anesthesiology Department, Faculty of Medicine of Cairo University, Cairo, Egypt.
Lecturer of Anesthesia, Anesthesiology Department, Faculty of Medicine of Cairo University, Cairo, Egypt.
Anesth Pain Med. 2021 Jul 3;11(3):e115152. doi: 10.5812/aapm.115152. eCollection 2021 Jun.
Effective perioperative fluid therapy is a great consideration.
Using lung ultrasound (LUS), this study evaluated the preference of the conventional and restrictive fluid replacement regimens for their volume impact in pediatric patients undergoing a relatively long procedure with limited volume loss (hypospadias repair).
Eighty pediatric patients scheduled for hypospadias repair surgery were enrolled for conventional (CG) or restrictive fluid management groups (RG). The CG obtained Ringer's lactate at the conventional calculated doses, while the RG obtained infusion of Ringer's lactate at a rate of 3 mL/kg/h. B-line numbers in the LUS, recovery score, urine output, blood pressure (BP), heart rate HR, and oxygen saturation (SpO) were recorded.
As evidenced by the LUS, RG showed a higher incidence of normal lung morphology with a mean and SD of 1.3 ± 2.2 for B-line numbers, whereas, in CG, they were 3.1 ± 2.2 with a P-value < 0.001. Urine output was 3.2 ± 0.8 and 2.9 ± 0.7 for CG and RG, respectively, with a P-value equal to 0.07. HR, BP, and SpO differences between groups were statistically insignificant. The recovery score was higher in RG (5.8 ± 0.4) than in CG (5.1 ± 0.8) at the first postoperative 20 minutes, with a P-value < 0.001.
In lengthy procedures with limited volume loss, using a moderately restrictive regimen is preferred over the conventional intraoperative fluid regimen considering both respiratory dysfunctions and recovery score.
有效的围手术期液体治疗是一个重要的考量因素。
本研究使用肺部超声（LUS）评估了传统和限制性液体替代方案对接受相对长时间手术且失液量有限（尿道下裂修复术）的儿科患者的容量影响的偏好。
80例计划接受尿道下裂修复手术的儿科患者被纳入传统（CG）或限制性液体管理组（RG）。CG组按传统计算剂量给予乳酸林格氏液，而RG组以3 mL/kg/h的速率输注乳酸林格氏液。记录LUS中的B线数量、恢复评分、尿量、血压（BP）、心率（HR）和血氧饱和度（SpO）。
LUS显示，RG组正常肺形态的发生率更高，B线数量的均值和标准差为1.3±2.2，而CG组为3.1±2.2，P值<0.001。CG组和RG组的尿量分别为3.2±0.8和2.9±0.7，P值等于0.07。两组之间的HR、BP和SpO差异无统计学意义。术后20分钟时，RG组的恢复评分（5.8±0.4）高于CG组（5.1±0.8），P值<0.001。
在失液量有限的长时间手术中，考虑到呼吸功能障碍和恢复评分，使用适度限制性方案优于传统的术中液体方案。
