2023年戴维·卡斯伯特森爵士的演讲. 一个流体之旅:影响临床实践的实验
1Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
不适当使用盐水溶液,特别是0.9%的盐水,可能导致高酸性化症,并使患者的结果恶化. 保持精确的液体平衡对于预防手术患者的并发症至关重要.
科学领域:
- 生物化学 生物化学
- 生理学 生理学 生理学
- 临床医学 临床医学
背景情况:
- 液体和电解质平衡对于患者的治疗结果至关重要.
- 不适当的液体治疗可能会导致严重的并发症.
- 现有研究强调了盐溶液和流体管理方面的问题.
研究的目的:
- 为了回顾25年来关于液体和电解质平衡的研究.
- 突出不适当使用盐水和流体管理的临床影响.
- 为了强调手术患者精确流体平衡的重要性.
主要方法:
- 文献综述和个人和外部研究的综合.
- 分析生化,生理和临床数据.
- 检查液体过载和缺陷对患者结果的影响.
主要成果:
- 过度使用0.9%盐水会导致高酸性化症,对器官系统产生负面影响,特别是脏.
- 液体过载 (体重增加>2.5公斤) 和缺陷都会使手术结果恶化,损害胃肠功能,增加并发症风险.
- 血清白蛋白主要受到稀释和炎症的影响,而不是营养状况.
结论:
- 准确的,接近零的液体平衡对于最佳的临床结果至关重要.
- 目前的指导方针 (GIFTASUP,NICE) 纳入这些发现,以改善外科手术期间的流体治疗.
- 基于证据的流体管理策略对于改善患者康复和减少并发症至关重要.
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