Trott S A, Beran S J, Rohrich R J, Kenkel J M, Adams W P, Klein K W
Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9132, USA.
Plast Reconstr Surg. 1998 Nov;102(6):2220-9. doi: 10.1097/00006534-199811000-00063.
There is no agreement as to appropriate fluid resuscitation in patients undergoing liposuction. This has assumed greater significance, as surgeons have undertaken larger volume aspirations (> or = 4 liters) and the potential complications of hypovolemia and fluid overload have materialized. This prospective study of 53 consecutive healthy patients undergoing liposuction using a superwet technique served to develop general guidelines for safe perioperative fluid management, especially in regard to large-volume aspirations. In this context, "aspirate" is defined as the total fat and fluid that is removed during liposuction. All patients were monitored using standard noninvasive hemodynamic monitoring. Thirty-six patients were monitored perioperatively with Foley catheters. The 53 patients underwent liposuction alone. We did not include patients who underwent concurrent aesthetic surgical procedures because our intention was to establish fluid administration guidelines for the liposuction patient. There were no significant complications in our series. The intraoperative fluid ratio, defined as (intravenous fluid + infiltrate)/aspirate, was 2.1 for the small-volume group and 1.4 for the large-volume group. These values were significantly different (p < .001, t test). Average urine output in the operating room and recovery room and on the floor was satisfactory (> 0.5 to 1 cc/kg/hr) and did not relate to volume aspirated (p = 0.21, 0.91, and 0.6, respectively, t test). Four patients who underwent "large-volume" aspirations (> or = 4 liters) had transient hypotension, which was immediately responsive to crystalloid fluid boluses in the first postoperative hours. All other patients required only maintenance intravenous crystalloid postoperatively until oral intake had been resumed. There were no statistically significant differences in postoperative fluid administration between the small- and large-volume groups. Ninety-three percent of patients were discharged within 24 hours of surgery. Our suggested guidelines for fluid resuscitation based on this retrospective study are as follows: (1) small volume (< 4 liters aspirated): maintenance fluid + subcutaneous wetting solution; (2) large volume (> or = 4 liters aspirated): maintenance fluid + subcutaneous wetting solution + 0.25 cc of intravenous crystalloid per cc of aspirate removed after 4 liters. This formula has since been used in the care of 94 patients who have undergone liposuction exclusively. All patients have had unremarkable hospital courses. These guidelines do not replace sound clinical judgment. Good communication between the surgeon and anesthesiologist is critical to optimal patient care and safety.
对于接受抽脂手术患者的适当液体复苏，目前尚无共识。随着外科医生进行更大抽吸量（≥4升）的抽脂手术，以及低血容量和液体超负荷等潜在并发症的出现，这一问题变得愈发重要。这项对53例连续接受使用超湿技术抽脂的健康患者进行的前瞻性研究，旨在制定安全的围手术期液体管理的一般指南，尤其是针对大容量抽吸。在此背景下，“吸出物”定义为抽脂过程中吸出的全部脂肪和液体。所有患者均采用标准无创血流动力学监测。36例患者在围手术期使用Foley导管进行监测。这53例患者仅接受抽脂手术。我们未纳入同时进行美容外科手术的患者，因为我们的目的是为抽脂患者制定液体管理指南。我们的系列研究中未出现显著并发症。术中液体比例，定义为（静脉输液量 + 浸润液量）/吸出物量，小容量组为2.1，大容量组为1.4。这些数值有显著差异（p <.001, t检验）。手术室、恢复室及病房的平均尿量令人满意（>0.5至1毫升/千克/小时），且与吸出量无关（分别为p = 0.21、0.91和0.6，t检验）。4例进行“大容量”抽吸（≥4升）的患者出现短暂性低血压，在术后最初数小时内对晶体液推注立即有反应。所有其他患者术后仅需维持静脉输注晶体液，直至恢复经口摄入。小容量组和大容量组术后液体管理无统计学显著差异。93%的患者在手术后24小时内出院。基于这项回顾性研究，我们建议的液体复苏指南如下：（1）小容量（吸出量<4升）：维持液 + 皮下浸润液；（2）大容量（吸出量≥4升）：维持液 + 皮下浸润液 + 每吸出4升后每毫升吸出物额外给予0.25毫升静脉晶体液。自此，该公式已用于仅接受抽脂手术的94例患者的护理。所有患者的住院过程均顺利。这些指南不能取代合理的临床判断。外科医生和麻醉医生之间的良好沟通对于实现最佳患者护理和安全至关重要。
