Lorente Juan V, Hahn Robert G, Jover José L, Del Cojo Enrique, Hervías Mónica, Jiménez Ignacio, Uña Rafael, Clau-Terré Fernando, Monge Manuel I, Llau Juan V, Colomina Maria J, Ripollés-Melchor Javier
Department of Anesthesiology and Critical Care, Juan Ramón Jiménez University Hospital, 21005 Huelva, Spain.
Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain.
J Clin Med. 2023 Sep 12;12(18):5930. doi: 10.3390/jcm12185930.
Perioperative fluid management, a critical aspect of major surgeries, is characterized by pronounced stress responses, altered capillary permeability, and significant fluid shifts. Recognized as a cornerstone of enhanced recovery protocols, effective perioperative fluid management is crucial for optimizing patient recovery and preventing postoperative complications, especially in high-risk patients. The scientific literature has extensively investigated various fluid infusion regimens, but recent publications indicate that not only the volume but also the type of fluid infused significantly influences surgical outcomes. Adequate fluid therapy prescription requires a thorough understanding of the physiological and biochemical principles that govern the body's internal environment and the potential perioperative alterations that may arise. Recently published clinical trials have questioned the safety of synthetic colloids, widely used in the surgical field. A new clinical scenario has arisen in which crystalloids could play a pivotal role in perioperative fluid therapy. This review aims to offer evidence-based clinical principles for prescribing fluid therapy tailored to the patient's physiology during the perioperative period. The approach combines these principles with current recommendations for enhanced recovery programs for surgical patients, grounded in physiological and biochemical principles.
围手术期液体管理是大手术的一个关键方面，其特点是明显的应激反应、毛细血管通透性改变和显著的液体转移。有效的围手术期液体管理被认为是加速康复方案的基石，对于优化患者康复和预防术后并发症至关重要，尤其是在高危患者中。科学文献已广泛研究了各种液体输注方案，但最近的出版物表明，不仅输注的液体量，而且输注的液体类型也会显著影响手术结果。开具充分的液体治疗处方需要透彻理解支配身体内环境的生理和生化原理以及围手术期可能出现的潜在改变。最近发表的临床试验对手术领域广泛使用的合成胶体的安全性提出了质疑。一种新的临床情况出现了，即晶体液可能在围手术期液体治疗中发挥关键作用。本综述旨在提供基于证据的临床原则，以便在围手术期根据患者的生理状况开具液体治疗处方。该方法将这些原则与目前针对手术患者加速康复计划的建议相结合，这些建议基于生理和生化原理。
