肖凌 1 , 黃真真 2 , 李蔚 3 , 薛瑛 1 , 汪曉東 2 , 李立 1
  • 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）;

目的  探索在快速流程模式下術(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。
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)院肛腸外科專業(yè)組收治的老年結(jié)直腸癌患者(≥60 歲)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）的臨床療效差異。
結(jié)果  限制補(bǔ)液組術(shù)后總并發(fā)癥發(fā)生率明顯低于常規(guī)補(bǔ)液組(P lt;0.05)，其中吻合口漏和肺部感染的發(fā)生率明顯低于常規(guī)補(bǔ)液組(P lt;0.05)。 2組患者均無(wú)圍手術(shù)期死亡發(fā)生。對(duì)于2組患者術(shù)后恢復(fù)情況，限制補(bǔ)液組患者的首次排氣、排便和進(jìn)食時(shí)間均早于常規(guī)補(bǔ)液組(P lt;0.05)。 限制補(bǔ)液組和常規(guī)補(bǔ)液組患者術(shù)前GLU 〔（6.70±2.93） mmol/L比（6.33±3.95） mmol/L〕、BUN 〔(5.84±2.03) mmol/L比（7.32±10.83） mmol/L〕及CREA 〔(76.19±19.85) μmol/L比（85.36±38.02） μmol/L〕的差異均有統(tǒng)計(jì)學(xué)意義(P lt;0.05)，術(shù)后其差異則無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05）。
結(jié)論  術(shù)后限制補(bǔ)液策略可以降低老年結(jié)直腸癌患者術(shù)后常見(jiàn)并發(fā)癥的發(fā)生率并加速患者的康復(fù)。

引用本文： 肖凌,黃真真,李蔚,薛瑛,汪曉東,李立. 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. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(1): 87-91. doi: 復(fù)制

1. Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures [J]. Ann Surg, 1961; 154 (5): 803810.
2. 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 multicenter trial [J]. Ann Surg, 2003; 238(5): 641648.
3. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
4. Mayor S. New approach to surgical care aims to improve recovery and reduce length of hospital stay [J]. BMJ, 2007; 334(7598): 816817.
5. 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.
6. 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.
7. 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.
8. Kobayashi H, Mochizuki H, Sugihara K, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study [J]. Surgery, 2007; 141(1): 6775.
9. Wedding U, Honecker F, Bokemeyer C, et al. Tolerance to chemotherapy in elderly patients with cancer [J]. Cancer Control, 2007; 14(1): 4456.
10. 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.
11. Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
12. 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.
13. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355360.
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. Ishikawa M, Nishioka M, Hanaki N, et al. Colorectal resection by a minilaparotomy approach vs. conventional operation for colon cancer. Results of a prospective randomized trial [J]. Hepatogastroenterology, 2007; 54(79): 19701975.
16. 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.
17. 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.
18. 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(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(7): 593596.
19. 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.
20. 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.
21. 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.
22. Moller 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.
23. 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.
24. Joshi GP. Intraoperative fluid rest riction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
25. Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 15041509.
  1. 1. Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures [J]. Ann Surg, 1961; 154 (5): 803810.
  2. 2. 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 multicenter trial [J]. Ann Surg, 2003; 238(5): 641648.
  3. 3. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
  4. 4. Mayor S. New approach to surgical care aims to improve recovery and reduce length of hospital stay [J]. BMJ, 2007; 334(7598): 816817.
  5. 5. 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.
  6. 6. 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.
  7. 7. 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.
  8. 8. Kobayashi H, Mochizuki H, Sugihara K, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study [J]. Surgery, 2007; 141(1): 6775.
  9. 9. Wedding U, Honecker F, Bokemeyer C, et al. Tolerance to chemotherapy in elderly patients with cancer [J]. Cancer Control, 2007; 14(1): 4456.
  10. 10. 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.
  11. 11. Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
  12. 12. 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.
  13. 13. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355360.
  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. Ishikawa M, Nishioka M, Hanaki N, et al. Colorectal resection by a minilaparotomy approach vs. conventional operation for colon cancer. Results of a prospective randomized trial [J]. Hepatogastroenterology, 2007; 54(79): 19701975.
  16. 16. 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.
  17. 17. 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.
  18. 18. 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(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(7): 593596.
  19. 19. 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.
  20. 20. 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.
  21. 21. 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.
  22. 22. Moller 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.
  23. 23. 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.
  24. 24. Joshi GP. Intraoperative fluid rest riction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601605.
  25. 25. Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 15041509.