目标导向性晶体液与胶体液输注对术后肺量计参数的影响：一项随机对照临床试验的子研究

The effect of goal-directed crystalloid versus colloid administration on postoperative spirometry parameters: a substudy of a randomized controlled clinical trial.

作者信息

Obradovic Mina, Luf Florian, Reiterer Christian, Schoppmann Sebastian, Kurz Andrea, Fleischmann Edith, Kabon Barbara

机构信息

Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.

Department of Anesthesiology and Intensive Care, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140 Wien, Vienna, Austria.

出版信息

Perioper Med (Lond). 2024 Apr 15;13(1):28. doi: 10.1186/s13741-024-00381-z.

DOI:10.1186/s13741-024-00381-z

PMID:38622671

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11020978/

Abstract

BACKGROUND

Pulmonary function is impaired after major abdominal surgery and might be less impaired by restrictive fluid administration. Under the assumption of a fluid-sparing effect of colloids, we tested the hypothesis that an intraoperative colloid-based goal-directed fluid management strategy impairs postoperative pulmonary function parameters less compared to goal-directed crystalloid administration.

METHODS

We performed a preplanned, single-center substudy within a recently published trial evaluating the effect of goal-directed crystalloids versus colloids on a composite of major complications. Sixty patients undergoing major open abdominal surgery were randomized to Doppler-guided intraoperative fluid replacement therapy with lactated Ringer's solution (n = 31) or unbalanced 6% hydroxyethyl starch 130/0.4 (n = 29). A blinded investigator performed bedside spirometry (Spirobank-G, Medical International Research, Rome, Italy) preoperatively as well as 6, 24, and 48 h postoperatively.

RESULTS

Median total intraoperative fluid requirements were significantly higher during crystalloid administration compared to patients receiving colloids (4567 ml vs. 3044 ml, p = 0.01). Six hours after surgery, pulmonary function parameters did not differ significantly between the crystalloid - and the colloid group: forced vital capacity (FVC): 1.6 l (1.2-2 l) vs. 1.9 l (1.5-2.4 l), p = 0.15; forced expiratory volume in 1 second (FEV1): 1.1 l (0.9-1.6 l) vs. 1.4 l (1.2-1.7 l), p = 0.18; and peak expiratory flow (PEF): 2 l.sec (1.5 - 3.6 l.sec ) vs. 2.3 l.sec (1.8 - 3.4 l.sec ), p = 0.23. Moreover, postoperative longitudinal time × group interactions of FVC, FEV1, and PEF between 6 and 48 postoperative hours did not differ significantly.

CONCLUSION

Postoperative pulmonary function parameters were similarly impaired in patients receiving goal-directed crystalloid administration as compared to goal-directed colloid administration during open abdominal surgery.

TRIAL REGISTRATION

ClinicalTrials.gov ( NCT00517127 , registered on August 16, 2007) and EudraCT (2005-004602-86).

摘要

背景

腹部大手术后肺功能会受损，而限制液体输入可能会减轻这种损害。基于胶体具有节约液体的作用这一假设，我们检验了以下假设：与目标导向性晶体液输注相比，术中基于胶体的目标导向性液体管理策略对术后肺功能参数的损害更小。

方法

我们在最近发表的一项评估目标导向性晶体液与胶体液对主要并发症综合影响的试验中进行了一项预先计划的单中心子研究。60例行腹部开放性大手术的患者被随机分为两组，一组接受多普勒引导下术中用乳酸林格氏液进行液体替代治疗（n = 31），另一组接受不平衡的6%羟乙基淀粉130/0.4治疗（n = 29）。一名盲法研究者在术前以及术后6、24和48小时进行床旁肺活量测定（使用Spirobank - G，Medical International Research，罗马，意大利）。

结果

与接受胶体液的患者相比，晶体液输注期间术中总液体需求量中位数显著更高（4567毫升对3044毫升，p = 0.01）。术后6小时，晶体液组和胶体液组的肺功能参数无显著差异：用力肺活量（FVC）：1.6升（1.2 - 2升）对1.9升（1.5 - 2.4升），p = 0.15；第1秒用力呼气量（FEV1）：1.1升（0.9 - 1.6升）对1.4升（1.2 - 1.7升），p = 0.18；呼气峰值流速（PEF）：2升·秒（1.5 - 3.6升·秒）对2.3升·秒（1.8 - 3.4升·秒），p = 0.23。此外，术后6至48小时FVC、FEV1和PEF的术后纵向时间×组间交互作用无显著差异。