肖凌 1,2,3 , 王浩洋 1,2,4 , 余曦 1,2,4 , 汪曉東 1,2 , 李立 1,2
  • 1.四川大學(xué)華西醫(yī)院胃腸外科中心(成都 610041);;
  • 2.四川大學(xué)華西醫(yī)院MCQ團(tuán)隊(成都 610041);;
  • 3.四川大學(xué)口腔醫(yī)學(xué)院(成都 610041;;
  • 4.四川大學(xué)華西臨床醫(yī)學(xué)院(成都 610041);

目的 探討在快速流程模式下不同體重指數(shù)(BMI)患者液體限制策略下的臨床效果。
方法 回顧性研究2008年1月至2009年1月期間四川大學(xué)華西醫(yī)院結(jié)直腸外科專業(yè)組收治的354例結(jié)直腸癌患者的病例資料,分析術(shù)后不同補液方式下不同BMI患者術(shù)后康復(fù)情況。
結(jié)果 從術(shù)后康復(fù)指標(biāo)看,限制補液組的術(shù)后首次排氣、排便及下床活動時間均早于常規(guī)補液組(P lt;0.05),且術(shù)后住院時間也更短(P lt;0.05)。常規(guī)補液組及限制補液組中的偏瘦組、正常組及超重組之間的術(shù)后康復(fù)情況的差異均無統(tǒng)計學(xué)意義(P gt;0.05)； 從術(shù)后并發(fā)癥的發(fā)生率看,限制補液組的肺部感染、吻合口漏、腸梗阻和傷口裂開的發(fā)生率均低于常規(guī)補液組(P lt;0.05)； 常規(guī)補液組中的超重組的吻合口漏和傷口裂開的發(fā)生率高于偏瘦組和正常組(P lt;0.05)。限制補液組中的3個亞組術(shù)后并發(fā)癥發(fā)生率的差異無統(tǒng)計學(xué)意義(P gt;0.05)。
結(jié)論 術(shù)后限制補液策略在超重結(jié)直腸癌患者的術(shù)后康復(fù)中效果良好,能促進(jìn)其術(shù)后早期康復(fù)。

引用本文： 肖凌,王浩洋,余曦,汪曉東,李立. 術(shù)后限制補液策略對不同體重指數(shù)結(jié)直腸癌患者的臨床效果研究. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(3): 289-293. doi: 復(fù)制

1. Schwenk W, Haase O, Raue W, et al. Establishing “fast track” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129(6): 502509.
2. 劉展, 汪曉東, 李立. 多學(xué)科協(xié)作診治模式下的結(jié)直腸外科快速康復(fù)流程 [J].中國普外基礎(chǔ)與臨床雜志, 2007; 14(2): 239242.
3. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 18121818.
4. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg, 2003; 238(5): 641648.
5. 肖凌, 黃真真, 李蔚, 等. 快速流程模式中術(shù)后限制補液在老年結(jié)直腸癌患者中的應(yīng)用價值 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(1): 8791.
6. 肖凌，李蔚， 麥玲， 等. 快速流程模式下術(shù)后限制補液對不同手術(shù)方案直腸癌患者康復(fù)情況的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(2): 190194.
7. 吳在德, 吳肇漢. 外科學(xué) [M]. 第7版. 北京: 人民衛(wèi)生出版社, 2008: 66.
8. Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
9. World Health Organization, media centre. overweight and obese. BMI classification. Available at: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed March 30, 2008.
10. 呂東昊, 汪曉東, 陽川華, 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6): 713716.
11. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355360.
12. Calle EE, Rodriguez C, WalkerThurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults [J]. N Engl J Med, 2003; 348(17): 16251638.
13. Merkow RP, Bilimoria KY, McCarter MD, et al. Effect of body mass index on shortterm outcomes after colectomy for cancer [J]. J Am Coll Surg, 2009; 208(1): 5361.
14. Sadr Azodi O, Lindstrm D, Adami J, et al. Impact of body mass index and tobacco smoking on outcome after open appendicectomy [J]. Br J Surg, 2008; 95(6): 751757.
15. Gendall KA, Raniga S, Kennedy R, et al. The impact of obesity on outcome after major colorectal surgery [J]. Dis Colon Rectum, 2007; 50(12): 22232237.
16. 肖凌, 汪曉東, 李立. 術(shù)后液體管理在結(jié)直腸外科快速流程中的應(yīng)用進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 17(7): 593596.
17. Norman K, Kirchner H, Lochs H, et al. Malnutrition affects quality of life in gastroenterology patients [J]. World J Gastroenterol, 2006; 12(21): 33803385.
18. Hannemann P, Lassen K, Hausel J, et al. Patterns in current anaesthesiological perioperative practice for colonic resections: a survey in five northernEuropean countries [J]. Acta Anaesthesiol Scand, 2006; 50(9): 11521160.
19. Soeters PB, de Zoete JP, Dejong CH, et al. Colorectal surgery and anastomotic leakage [J]. Dig Surg, 2002; 19(2): 150155.
20. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
21. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
22. Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg, 2006; 93(9): 10691076.
23. Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
24. HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med,1997; 23(3): 276281.
25. Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.
26. Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
27. von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
28. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
29. Dindo D, Muller MK, Weber M, et al. Obesity in general elective surgery [J]. Lancet, 2003; 361(9374): 20322035.
30. Benoist S, Panis Y, Alves A, et al. Impact of obesity on surgical outcomes after colorectal resection [J]. Am J Surg, 2000; 179(4): 275281.
31. Smith RL, Bohl JK, McElearney ST, et al. Wound infection after elective colorectal resection [J]. Ann Surg, 2004; 239(5): 599605.
32. Chappell D, Jacob M, HofmannKiefer K, et al. A rational approach to perioperative fluid management [J]. Anesthesiology, 2008; 109(4): 723740.
  1. 1. Schwenk W, Haase O, Raue W, et al. Establishing “fast track” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129(6): 502509.
  2. 2. 劉展, 汪曉東, 李立. 多學(xué)科協(xié)作診治模式下的結(jié)直腸外科快速康復(fù)流程 [J].中國普外基礎(chǔ)與臨床雜志, 2007; 14(2): 239242.
  3. 3. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 18121818.
  4. 4. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg, 2003; 238(5): 641648.
  5. 5. 肖凌, 黃真真, 李蔚, 等. 快速流程模式中術(shù)后限制補液在老年結(jié)直腸癌患者中的應(yīng)用價值 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(1): 8791.
  6. 6. 肖凌，李蔚， 麥玲， 等. 快速流程模式下術(shù)后限制補液對不同手術(shù)方案直腸癌患者康復(fù)情況的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(2): 190194.
  7. 7. 吳在德, 吳肇漢. 外科學(xué) [M]. 第7版. 北京: 人民衛(wèi)生出版社, 2008: 66.
  8. 8. Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
  9. 9. World Health Organization, media centre. overweight and obese. BMI classification. Available at: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed March 30, 2008.
  10. 10. 呂東昊, 汪曉東, 陽川華, 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6): 713716.
  11. 11. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355360.
  12. 12. Calle EE, Rodriguez C, WalkerThurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults [J]. N Engl J Med, 2003; 348(17): 16251638.
  13. 13. Merkow RP, Bilimoria KY, McCarter MD, et al. Effect of body mass index on shortterm outcomes after colectomy for cancer [J]. J Am Coll Surg, 2009; 208(1): 5361.
  14. 14. Sadr Azodi O, Lindstrm D, Adami J, et al. Impact of body mass index and tobacco smoking on outcome after open appendicectomy [J]. Br J Surg, 2008; 95(6): 751757.
  15. 15. Gendall KA, Raniga S, Kennedy R, et al. The impact of obesity on outcome after major colorectal surgery [J]. Dis Colon Rectum, 2007; 50(12): 22232237.
  16. 16. 肖凌, 汪曉東, 李立. 術(shù)后液體管理在結(jié)直腸外科快速流程中的應(yīng)用進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 17(7): 593596.
  17. 17. Norman K, Kirchner H, Lochs H, et al. Malnutrition affects quality of life in gastroenterology patients [J]. World J Gastroenterol, 2006; 12(21): 33803385.
  18. 18. Hannemann P, Lassen K, Hausel J, et al. Patterns in current anaesthesiological perioperative practice for colonic resections: a survey in five northernEuropean countries [J]. Acta Anaesthesiol Scand, 2006; 50(9): 11521160.
  19. 19. Soeters PB, de Zoete JP, Dejong CH, et al. Colorectal surgery and anastomotic leakage [J]. Dig Surg, 2002; 19(2): 150155.
  20. 20. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
  21. 21. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
  22. 22. Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg, 2006; 93(9): 10691076.
  23. 23. Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
  24. 24. HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med,1997; 23(3): 276281.
  25. 25. Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.
  26. 26. Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
  27. 27. von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
  28. 28. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
  29. 29. Dindo D, Muller MK, Weber M, et al. Obesity in general elective surgery [J]. Lancet, 2003; 361(9374): 20322035.
  30. 30. Benoist S, Panis Y, Alves A, et al. Impact of obesity on surgical outcomes after colorectal resection [J]. Am J Surg, 2000; 179(4): 275281.
  31. 31. Smith RL, Bohl JK, McElearney ST, et al. Wound infection after elective colorectal resection [J]. Ann Surg, 2004; 239(5): 599605.
  32. 32. Chappell D, Jacob M, HofmannKiefer K, et al. A rational approach to perioperative fluid management [J]. Anesthesiology, 2008; 109(4): 723740.