Hussen Mostafa Adam Mosab, Bakhit Sara, Ahmed Mohamed E, Almahal Mohamed A, Ali Hiba A, Ahmed Mayada O, Ibrahim Basil A, Elmustafa Fatima A, Ibrahim Sara N, Salim Omer El Faroug H
Orthopedics, University of Khartoum, Khartoum, SDN.
Faculty of Medicine, University of Khartoum, Khartoum, SDN.
Cureus. 2024 Oct 17;16(10):e71709. doi: 10.7759/cureus.71709. eCollection 2024 Oct.
Postoperative fluid and electrolyte management is crucial for adequate patients' recovery and healing. This audit aimed to assess the current practice of postoperative intravenous fluids (IV) and electrolyte administration and investigate postoperative electrolyte disturbances.
This study was conducted at Soba Teaching Hospital and comprised two cycles, it examined adult patients who underwent abdominal surgery and were exclusively on postoperative intravenous fluid therapy for at least one day. Exclusions were made for certain conditions (Heart or renal failure, ICU admissions, day surgeries). Data collected from medical records including intravenous fluid types and amounts, electrolytes, and daily serum sodium and potassium levels, were compared to British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP). Following cycle one, regular educational sessions were conducted for medical staff, emphasizing the need for improved practices in postoperative care.
A total of 14 patients in cycle one and 15 patients in cycle two were included. The data analysis unit was the patient-day. Patient-days refers to the total number of days patients were on IV fluids after surgery, starting from the day after the operation and excluding the day of surgery. It is calculated by adding up the number of days each patient remained exclusively on IV fluids. A total of 33 and 30 patient-days were analyzed in cycle one and cycle two respectively. The recommended daily amount of IV fluids for maintenance was given in 0.00% of patient-days in cycle one as compared to 76.7% in cycle two. Sodium and potassium doses were given within the recommended range of 0.00% and 24% patient-days respectively in cycle one. In cycle two, sodium and potassium were given according to the guidelines in 46.7% and 60% of patient-days respectively. Electrolyte disturbances occurred in 69.7% of patient-days in cycle one, decreasing to 46.7% in cycle two, primarily in the form of hyponatremia and hypokalemia.
This study highlighted the need for continued monitoring and emphasized the importance of adequate medical staff training about postoperative IV fluids and electrolytes.
术后液体和电解质管理对于患者的充分康复和愈合至关重要。本次审核旨在评估术后静脉输液（IV）和电解质给药的当前实践情况，并调查术后电解质紊乱情况。
本研究在索巴教学医院进行，包括两个周期，研究对象为接受腹部手术且术后至少一天仅接受静脉输液治疗的成年患者。排除某些情况（心力衰竭或肾衰竭、入住重症监护病房、日间手术）的患者。从病历中收集的数据，包括静脉输液类型和数量、电解质以及每日血清钠和钾水平，与英国《成人外科患者静脉输液治疗共识指南》（GIFTASUP）进行比较。在第一个周期之后，为医务人员举办了定期教育课程，强调了改善术后护理实践的必要性。
第一个周期共纳入14例患者，第二个周期纳入15例患者。数据分析单位是患者日。患者日指患者术后接受静脉输液的总天数，从手术后第二天开始计算，不包括手术当天。通过将每位患者仅接受静脉输液的天数相加得出。第一个周期和第二个周期分别共分析了33个和30个患者日。第一个周期中，维持所需的推荐每日静脉输液量在0.00%的患者日中给予，而第二个周期为76.7%。第一个周期中，钠和钾剂量分别在0.00%和24%的患者日中处于推荐范围内。在第二个周期中，钠和钾分别在46.7%和60%的患者日中按照指南给予。第一个周期中69.7%的患者日出现电解质紊乱，第二个周期降至46.7%，主要表现为低钠血症和低钾血症。
本研究强调了持续监测的必要性，并强调了对医务人员进行充分的术后静脉输液和电解质培训的重要性。
