肖凌 1 , 黃真真 2 , 李蔚 3 , 薛瑛 1 , 汪曉東 2 , 李立 1
  • 1.四川大學華西醫(yī)院胃腸外科中心（成都 610041）;;
  • 2.四川大學華西醫(yī)院MCQ團隊（成都 610041）;;
  • 3.四川大學華西口腔醫(yī)學院（成都 610041）;

目的  探索在快速流程模式下術后限制補液在老年結直腸癌患者中的應用價值。
方法  回顧性研究2008年1月至2009年1月期間四川大學華西醫(yī)院肛腸外科專業(yè)組收治的老年結直腸癌患者(≥60 歲)的臨床資料， 分析比較采用不同補液方案（限制補液組和常規(guī)補液組）的臨床療效差異。
結果  限制補液組術后總并發(fā)癥發(fā)生率明顯低于常規(guī)補液組(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)補液組(P lt;0.05)。 2組患者均無圍手術期死亡發(fā)生。對于2組患者術后恢復情況，限制補液組患者的首次排氣、排便和進食時間均早于常規(guī)補液組(P lt;0.05)。 限制補液組和常規(guī)補液組患者術前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)計學意義(P lt;0.05)，術后其差異則無統(tǒng)計學意義（P gt;0.05）。
結論  術后限制補液策略可以降低老年結直腸癌患者術后常見并發(fā)癥的發(fā)生率并加速患者的康復。

引用本文： 肖凌,黃真真,李蔚,薛瑛,汪曉東,李立. 快速流程模式中術后限制補液在老年結直腸癌患者中的應用價值. 中國普外基礎與臨床雜志, 2010, 17(1): 87-91. doi: 復制

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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.
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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. 多學科協(xié)作診治模式下的結直腸外科快速康復流程 [J]. 中國普外基礎與臨床雜志, 2007； 14(2): 239242.
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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.
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12. 呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協(xié)作診治模式的數(shù)據(jù)庫初期建設現(xiàn)狀 [J]. 中國普外基礎與臨床雜志, 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. 術后液體管理在結直腸外科快速流程中的應用進展 [J]. 中國普外基礎與臨床雜志, 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. 多學科協(xié)作診治模式下的結直腸外科快速康復流程 [J]. 中國普外基礎與臨床雜志, 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 [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, 陽川華, 等. 結直腸腫瘤多學科協(xié)作診治模式的數(shù)據(jù)庫初期建設現(xiàn)狀 [J]. 中國普外基礎與臨床雜志, 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. 術后液體管理在結直腸外科快速流程中的應用進展 [J]. 中國普外基礎與臨床雜志, 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.