李蔚 1,2,3 , 肖凌 1,2,3 , 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(duì)(成都 610041);;
  • 3.四川大學(xué)華西口腔醫(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 　探究限制補(bǔ)液策略對(duì)結(jié)直腸癌伴糖尿病患者術(shù)后早期康復(fù)的臨床價(jià)值。
　方法 　回顧性研究2007年1月至2009年10月期間四川大學(xué)華西醫(yī)院結(jié)直腸外科專業(yè)組收治的伴糖尿病的結(jié)直腸癌患者的臨床資料，分析比較采用不同補(bǔ)液方案(限制補(bǔ)液組和常規(guī)補(bǔ)液組)的術(shù)后首次排氣、進(jìn)食、下床活動(dòng)及住院時(shí)間，術(shù)后早期并發(fā)癥(傷口感染、吻合口漏、腸梗阻)，生化與血常規(guī)檢查指標(biāo)(血紅蛋白、白細(xì)胞計(jì)數(shù)、葡萄糖、尿素氮)。
　結(jié)果 　限制補(bǔ)液組術(shù)后首次排氣及下床活動(dòng)時(shí)間均早于常規(guī)補(bǔ)液組(P lt;0.05)，而2組術(shù)后首次進(jìn)食、術(shù)后住院時(shí)間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。在術(shù)后早期并發(fā)癥方面，限制補(bǔ)液組的傷口感染率明顯低于常規(guī)補(bǔ)液組(P lt;0.05)，而2組間吻合口〖漏及腸梗阻發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。生化與血常規(guī)檢查指標(biāo)，術(shù)前2組患者各指標(biāo)的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)； 術(shù)后限制補(bǔ)液組葡萄糖水平明顯低于常規(guī)補(bǔ)液組(P lt;0.05)，其余指標(biāo)2組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。
　結(jié)論　 術(shù)后限制補(bǔ)液策略可以降低伴糖尿病的結(jié)直腸癌患者術(shù)后常見并發(fā)癥的發(fā)生率并有利于患者的康復(fù)。

引用本文： 李蔚,肖凌,余曦,汪曉東,李立. 限制補(bǔ)液策略有利于結(jié)直腸癌伴糖尿病患者術(shù)后的早期安全康復(fù). 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(4): 399-403. doi: 復(fù)制

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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(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(2): 239-242.
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4. 　肖凌, 黃真真, 李蔚, 等. 快速流程模式中術(shù)后限制補(bǔ)液在老年結(jié)直腸癌患者中的應(yīng)用價(jià)值 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(1): 87-91.
5. 　Bower WF, Lee PY, Kong AP, et al. Peri-operative hyperglycemia: a consideration for general surgery? [J]. Am J Surg, 2010; 199(2): 240-248.
6. 　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.
7. 　Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323-332.
8. 　呂東昊, 汪曉東, 陽(yáng)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(kù)初期建設(shè)現(xiàn)狀 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(6): 713-716.
9. 　Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355-360.
10. 　Dronge AS, Perkal MF, Kancir S, et al. Long-term glycemic control and postoperative infectious complications [J]. Arch Surg, 2006; 141(4): 375-380.
11. 　Chung YW, Han DS, Park KH, et al. Insulin therapy and colorectal adenoma risk among patients with type 2 diabetes mellitus: a case-control study in Korea [J]. Dis Colon Rectum, 2008; 51(5): 593-597.
12. 　Christopherson K. The impact of diabetes on wound healing: implications of microcirculatory changes [J]. Br J Community Nurs, 2003; 8(12): S6-S13.
13. 　Mousley M. Diabetes and its effect on wound healing and patient care [J]. Nurs Times, 2003; 99(42): 70, 73-74.
14. 　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.
15. 　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.
16. 　Lobo DN, Bjarnason K, Field J, et al. Changes in weight, fluid balance and serum albumin in patients referred for nutritional support [J]. Clin Nutr, 1999; 18: 197-201.
17. 　Mller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 57-62.
18. 　MacKay G, Fearon K, McConnachie A, et al. Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 1469-1474.
19. 　Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601-605.
20. 　Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 1504-1509.
21. 　Wellby ML, Kennedy JA, Barreau PB, et al. Endocrine and cytokine changes during elective surgery [J]. J Clin Pathol,1994; 47(11): 1049-1051.
22. 　Desborough JP. The stress response to surgery [J]. Br J Anaesth, 2000; 85(1): 109-117.
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. 　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.
25. 　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.
  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(guó)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. 　肖凌, 黃真真, 李蔚, 等. 快速流程模式中術(shù)后限制補(bǔ)液在老年結(jié)直腸癌患者中的應(yīng)用價(jià)值 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(1): 87-91.
  5. 5. 　Bower WF, Lee PY, Kong AP, et al. Peri-operative hyperglycemia: a consideration for general surgery? [J]. Am J Surg, 2010; 199(2): 240-248.
  6. 6. 　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.
  7. 7. 　Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323-332.
  8. 8. 　呂東昊, 汪曉東, 陽(yáng)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(kù)初期建設(shè)現(xiàn)狀 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(6): 713-716.
  9. 9. 　Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355-360.
  10. 10. 　Dronge AS, Perkal MF, Kancir S, et al. Long-term glycemic control and postoperative infectious complications [J]. Arch Surg, 2006; 141(4): 375-380.
  11. 11. 　Chung YW, Han DS, Park KH, et al. Insulin therapy and colorectal adenoma risk among patients with type 2 diabetes mellitus: a case-control study in Korea [J]. Dis Colon Rectum, 2008; 51(5): 593-597.
  12. 12. 　Christopherson K. The impact of diabetes on wound healing: implications of microcirculatory changes [J]. Br J Community Nurs, 2003; 8(12): S6-S13.
  13. 13. 　Mousley M. Diabetes and its effect on wound healing and patient care [J]. Nurs Times, 2003; 99(42): 70, 73-74.
  14. 14. 　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.
  15. 15. 　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.
  16. 16. 　Lobo DN, Bjarnason K, Field J, et al. Changes in weight, fluid balance and serum albumin in patients referred for nutritional support [J]. Clin Nutr, 1999; 18: 197-201.
  17. 17. 　Mller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 57-62.
  18. 18. 　MacKay G, Fearon K, McConnachie A, et al. Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 1469-1474.
  19. 19. 　Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601-605.
  20. 20. 　Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 1504-1509.
  21. 21. 　Wellby ML, Kennedy JA, Barreau PB, et al. Endocrine and cytokine changes during elective surgery [J]. J Clin Pathol,1994; 47(11): 1049-1051.
  22. 22. 　Desborough JP. The stress response to surgery [J]. Br J Anaesth, 2000; 85(1): 109-117.
  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. 　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.
  25. 25. 　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.