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);;
  • 3.四川大學口腔醫(yī)學院(成都 610041;;
  • 4.四川大學華西臨床醫(yī)學院(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月期間四川大學華西醫(yī)院結直腸外科專業(yè)組收治的354例結直腸癌患者的病例資料,分析術后不同補液方式下不同BMI患者術后康復情況。
結果 從術后康復指標看,限制補液組的術后首次排氣、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后康復情況的差異均無統(tǒng)計學意義(P gt;0.05)； 從術后并發(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個亞組術后并發(fā)癥發(fā)生率的差異無統(tǒng)計學意義(P gt;0.05)。
結論 術后限制補液策略在超重結直腸癌患者的術后康復中效果良好,能促進其術后早期康復。

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

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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.
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. 快速流程模式中術后限制補液在老年結直腸癌患者中的應用價值 [J]. 中國普外基礎與臨床雜志, 2010; 17(1): 8791.
6. 肖凌，李蔚， 麥玲， 等. 快速流程模式下術后限制補液對不同手術方案直腸癌患者康復情況的影響 [J]. 中國普外基礎與臨床雜志, 2010; 17(2): 190194.
7. 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.
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.
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; 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.
  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. 快速流程模式中術后限制補液在老年結直腸癌患者中的應用價值 [J]. 中國普外基礎與臨床雜志, 2010; 17(1): 8791.
  6. 6. 肖凌，李蔚， 麥玲， 等. 快速流程模式下術后限制補液對不同手術方案直腸癌患者康復情況的影響 [J]. 中國普外基礎與臨床雜志, 2010; 17(2): 190194.
  7. 7. 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.
  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.
  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; 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.