目标导向液体治疗不能减少择期腹腔镜结直肠手术的原发性术后肠梗阻的发生：随机对照临床试验
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Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery: A Randomized Controlled Trial
背景与目的
围术期液体治疗不充足可影响胃肠道功能。评估目标导向性液体治疗对原发性术后肠梗阻影响的相关研究较缺乏。本研究的目的是明确目标导向性液体治疗是否减少了腹腔镜结直肠手术后原发性肠梗阻的发生率。
方 法
纳入腹腔镜结直肠手术后进行术后康复的成年患者进行评估者盲法的随机对照试验。把患者随机分为接受术中目标导向性液体治疗（目标导向液体治疗组）或传统的液体治疗（对照组）。原发性术后肠梗阻为主要结局。
结 果
纳入和分析了128名患者（目标导向型治疗组：n = 64;对照组：n = 64）。目标导向性治疗组的原发性术后肠梗阻发生率为22％，对照组为22％（相对危险度为1; 95％CI为0.5〜1.9; P = 1.00）。在术中，目标导向液体治疗组的患者接受较少的静脉输液（主要是较少的晶体液）和大量的胶体液。目标导向液体治疗组的每搏输出量和心输出量增加更为明显并持续。两组的住院时间、术后30天发病率和死亡率没有差异。
结 论
术中目标导向液体治疗与传统的液体治疗相比，在术后康复过程中，腹腔镜结直肠手术患者的原发性术后肠梗阻并不能降低。
原始文献摘要
Hu D, Flick RP, Zaccariello MJ, et al.Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort[J]. Anesthesiology, 2017. [Epub ahead of print] doi: 10.1097/ALN.0000000000001735.
Background: Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program.
Methods: Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome.
Results: One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different.
Conclusions: Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.
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