• 四川大學(xué)華西醫(yī)院肛腸外科(成都 610041);

目的  探討術(shù)后液體管理在結(jié)直腸外科快速流程（fast track）中的應(yīng)用進(jìn)展。
方法  查閱有關(guān)液體管理與結(jié)直腸外科的文獻(xiàn)并進(jìn)行分析。
結(jié)果  相對(duì)于術(shù)后開(kāi)放補(bǔ)液，限制補(bǔ)液可以減少并發(fā)癥發(fā)生率，減少住院時(shí)間和改善術(shù)后生存率。晶體膠體聯(lián)合補(bǔ)液優(yōu)于單純使用晶體液。
結(jié)論  術(shù)后補(bǔ)液量和補(bǔ)液類型影響患者的康復(fù)情況，這也是快速流程所關(guān)注的問(wèn)題。

引用本文： 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. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(7): 593-596. doi: 復(fù)制

1. 劉展， 汪曉東， 李立. 結(jié)直腸外科快速流程內(nèi)容及依據(jù) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2007; 14(4): 469473.
2. 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.
3. Gan TJ, Soppitt A, Maroof M, et al. Goaldirected intraoperative fluid administration reduces length of hospital stay after major surgery [J]. Anesthesiology, 2002; 97(4): 820826.
4. 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.
5. 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.
6. Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures [J]. Ann Surg, 1961; 154(5): 803810.
7. Moore FD. Metabolic Care of the Surgical Patient[Ｍ]. Philadelphia:W.B.Saunders, 1959.
8. Sear JW. Kidney dysfunction in the postoperative period [J]. Br J Anaesth, 2005; 95(1): 2032.
9. Ali SZ, Taguchi A, Holtmann B, et al. Effect of supplemental preoperative fluid on postoperative nausea and vomiting [J]. Anaesthesia, 2003; 58（8）: 780784.
10. Scheingraber S, Rehm M, Sehmisch C, et al. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery [J]. Anesthesiology, 1999; 90(5): 12651270.
11. Wakeling HG, McFall MR, Jenkins CS, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery [J]. Br J Anaesth, 2005; 95(5): 634642.
12. Prough DS, Bidani A. Hyperchloremic metabolic acidosis is a predictable consequence of intraoperative infusion of 0.9% saline [J]. Anesthesiology, 1999; 90(5): 12471249.
13. Brandstrup B. Fluid therapy for the surgical patient [J]. Best Pract Res Clin Anaesthesiol, 2006; 20(2): 265283.
14. 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.
15. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
16. Perco MJ, Jarnvig IL, HjgaardRasmussen N, et al. Electric impedance for evaluation of body fluid balance in cardiac surgical patients [J]. J Cardiothorac Vasc Anesth, 2001; 15(1): 4448.
17. Mayor S. New approach to surgical care aims to improve recovery and reduce length of hospital stay [J]. BMJ, 2007; 334(7598): 816817.
18. Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery [J]. Anesthesiology, 2005; 103(1): 2532.
19. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: its effect on the gastric emptying time before and after gastric operations.1937 [J]. Nutrition, 1990; 6(4): 278290.
20. 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.
21. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessorblinded multicenter trial [J]. Ann Surg, 2003; 238(5): 641648.
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. 李民, 李幼生, 李寧， 等. 加速康復(fù)外科與圍手術(shù)期液體治療 [J]. 實(shí)用臨床醫(yī)藥雜志, 2007; 11(5): 46.
25. Price J, Sear J, Venn R. Perioperative fluid volume optimization following proximal femoral fracture [DB/OL]. Cochrane Database Syst Rev, 2002; (1): CD003004. Oxford: Update Software. www.cochrane.org.
26. Desborough JP. The stress response to trauma and surgery [J]. Br J Anaesth, 2005; 85(1): 109117.
27. Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions [J]. Endocr Rev, 2000; 21(1): 5589.
28. Chappell D, Jacob M, HofmannKiefer K, et al. A rational approach to perioperative fluid management [J]. Anesthesiology, 2008; 109(4): 723740.
29. Boyd O, Bennett ED. Achieving the goal [J]. Crit Care Med, 1999; 27(10): 22982299.
30. 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.
31. 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(4): 197201.
32. 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.
33. 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.
34. 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.
35. 鄧碩曾. 圍術(shù)期液體治療的進(jìn)展與評(píng)價(jià) [J]. 臨床麻醉學(xué)雜志, 2003; 19(7): 439441.
36. Arieff AI. Fatal postoperative pulmonary edema: pathogenesis and literature review [J].Chest,1999;115(5): 13711377.
37. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
38. Schortgen F, Girou E, Deye N, et al. The risk associated with hyperoncotic colloids in patients with shock [J]. Intensive Care Med, 2008; 34(12): 21572168.
39. Kondo Y, Nagai H, Kasahara K, et al. The therapeutic effect of hypertonic solutions on the changes in the effective circulating plasma volume in acute necrotizing pancreatitis in rats [J]. Surg Today, 1998; 28(12): 12471253.
40. 汪建平. 重視結(jié)直腸癌外科手術(shù)患者術(shù)后生存質(zhì)量的提高[J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2007； 14（6）： 625627.
  1. 1. 劉展， 汪曉東， 李立. 結(jié)直腸外科快速流程內(nèi)容及依據(jù) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2007; 14(4): 469473.
  2. 2. 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.
  3. 3. Gan TJ, Soppitt A, Maroof M, et al. Goaldirected intraoperative fluid administration reduces length of hospital stay after major surgery [J]. Anesthesiology, 2002; 97(4): 820826.
  4. 4. 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.
  5. 5. 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.
  6. 6. Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures [J]. Ann Surg, 1961; 154(5): 803810.
  7. 7. Moore FD. Metabolic Care of the Surgical Patient[Ｍ]. Philadelphia:W.B.Saunders, 1959.
  8. 8. Sear JW. Kidney dysfunction in the postoperative period [J]. Br J Anaesth, 2005; 95(1): 2032.
  9. 9. Ali SZ, Taguchi A, Holtmann B, et al. Effect of supplemental preoperative fluid on postoperative nausea and vomiting [J]. Anaesthesia, 2003; 58（8）: 780784.
  10. 10. Scheingraber S, Rehm M, Sehmisch C, et al. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery [J]. Anesthesiology, 1999; 90(5): 12651270.
  11. 11. Wakeling HG, McFall MR, Jenkins CS, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery [J]. Br J Anaesth, 2005; 95(5): 634642.
  12. 12. Prough DS, Bidani A. Hyperchloremic metabolic acidosis is a predictable consequence of intraoperative infusion of 0.9% saline [J]. Anesthesiology, 1999; 90(5): 12471249.
  13. 13. Brandstrup B. Fluid therapy for the surgical patient [J]. Best Pract Res Clin Anaesthesiol, 2006; 20(2): 265283.
  14. 14. 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.
  15. 15. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
  16. 16. Perco MJ, Jarnvig IL, HjgaardRasmussen N, et al. Electric impedance for evaluation of body fluid balance in cardiac surgical patients [J]. J Cardiothorac Vasc Anesth, 2001; 15(1): 4448.
  17. 17. Mayor S. New approach to surgical care aims to improve recovery and reduce length of hospital stay [J]. BMJ, 2007; 334(7598): 816817.
  18. 18. Nisanevich V, Felsenstein I, Almogy G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery [J]. Anesthesiology, 2005; 103(1): 2532.
  19. 19. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: its effect on the gastric emptying time before and after gastric operations.1937 [J]. Nutrition, 1990; 6(4): 278290.
  20. 20. 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.
  21. 21. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessorblinded multicenter trial [J]. Ann Surg, 2003; 238(5): 641648.
  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. 李民, 李幼生, 李寧， 等. 加速康復(fù)外科與圍手術(shù)期液體治療 [J]. 實(shí)用臨床醫(yī)藥雜志, 2007; 11(5): 46.
  25. 25. Price J, Sear J, Venn R. Perioperative fluid volume optimization following proximal femoral fracture [DB/OL]. Cochrane Database Syst Rev, 2002; (1): CD003004. Oxford: Update Software. www.cochrane.org.
  26. 26. Desborough JP. The stress response to trauma and surgery [J]. Br J Anaesth, 2005; 85(1): 109117.
  27. 27. Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions [J]. Endocr Rev, 2000; 21(1): 5589.
  28. 28. Chappell D, Jacob M, HofmannKiefer K, et al. A rational approach to perioperative fluid management [J]. Anesthesiology, 2008; 109(4): 723740.
  29. 29. Boyd O, Bennett ED. Achieving the goal [J]. Crit Care Med, 1999; 27(10): 22982299.
  30. 30. 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.
  31. 31. 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(4): 197201.
  32. 32. 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.
  33. 33. 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.
  34. 34. 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.
  35. 35. 鄧碩曾. 圍術(shù)期液體治療的進(jìn)展與評(píng)價(jià) [J]. 臨床麻醉學(xué)雜志, 2003; 19(7): 439441.
  36. 36. Arieff AI. Fatal postoperative pulmonary edema: pathogenesis and literature review [J].Chest,1999;115(5): 13711377.
  37. 37. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
  38. 38. Schortgen F, Girou E, Deye N, et al. The risk associated with hyperoncotic colloids in patients with shock [J]. Intensive Care Med, 2008; 34(12): 21572168.
  39. 39. Kondo Y, Nagai H, Kasahara K, et al. The therapeutic effect of hypertonic solutions on the changes in the effective circulating plasma volume in acute necrotizing pancreatitis in rats [J]. Surg Today, 1998; 28(12): 12471253.
  40. 40. 汪建平. 重視結(jié)直腸癌外科手術(shù)患者術(shù)后生存質(zhì)量的提高[J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2007； 14（6）： 625627.