摘要
术后肺部并发症是手术病人预后的重要影响因素。有关围手术最适合的液体治疗剂量及种类的争论,目前尚无定论。不过,近年来有关过度液体治疗会导致术后肺部并发症增加的证据在不断增多。最近有研究表明,适当的减少围手术期液体治疗量(即限制性液体治疗)能降低择期胃肠大手术的术后肺部并发症发生率。限制性液体治疗的益处,不单单是减少了晶体液的给予量,同时可能与胶体的使用有关。有文献推荐,围手术期的液体管理包括:麻醉期间不给予麻醉前的预充量;晶体仅用维持剂量,用胶体来稳定血流动力学以及保证尿量[0.5mL(/kg·h)];出血等液体丢失用胶体来等容替代;不推荐给予第三间隙和利尿等液体的丢失等。此外,监测血乳酸水平可早期发现和纠正限制性液体治疗所致的组织低灌注,从而减少并发症。不过,何为围手术期的最佳液体治疗种类和剂量,还需要更严密、合理的研究。
Postoperative pulmonary complications （PPCs） frequently result in serious morbidity and mortality. Recent evidence suggests that judicious perioperative fluid therapy reduces PPCs after major elective gastrointestinal surgery. The observed benefits may not be solely attributable to crystalloid restriction but also to the use of colloids instead. Some clinically useful guidelines include elimination of preload for patients who receive epidural analgesia. A balanced approach to fluid management is recommended, with colloids administered to provide hemodynamic stability and maintain urine output of 0.5mL（kg·h） and crystalloids administered only for maintenance. Blood loss may be replaced with colloid on a volume-to-volume basis. In addition, predetermined algorithms that suggest replacement of third space losses and losses through diuresis are unnecessary. Furthermore, close monitoring of serum lactate levels with adjustment of intravenous fluid administration intraoperatively and in the early postoperative period may improve the early detection and correction of inadequate tissue perfusion. Finally, there is a need for more well-controlled studies in a well defined patient population using clear criteria or endpoints for perioperative fluid therapy.
出处
《中国实用外科杂志》
CSCD
北大核心
2011年第2期126-129,共4页
Chinese Journal of Practical Surgery
关键词
肺部并发症
液体治疗
围手术期
pulmonary complications
fluid therapy
preoperative peroid
