在结直肠外科手术中进行外科手术期间的流体管理:对标准化实践的机构方法
Philip Deslarzes1, Jonas Jurt1, David W Larson2
1Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), 1005 Lausanne, Switzerland.
Journal of clinical medicine
|February 10, 2024
概括
本综述检查了在手术后增强康复 (ERAS) 中限制性外科手术周流体协议. 总静脉注射液体和体重增加的临界值影响术后结果,指导标准化的ERAS流体管理.
科学领域:
- 麻醉学 麻醉学
- 手术重症监护手术重症监护
- 在外科手术期间的医学.
背景情况:
- 手术后增强恢复 (ERAS) 途径通常利用外科手术期间的流体管理,但限制性与自由流体方案的定义缺乏标准化.
- 相互矛盾的证据,机构差异和个人偏好导致流体管理策略的模糊性.
- 在标准化的ERAS协议中,选择适合限制性流体协议的患者存在挑战.
研究的目的:
- 在ERAS途径的背景下,审查限制性外科手术周流体协议.
- 确定总静脉注射液体和影响术后结果的体重增加的关键值.
- 引入对标准化外科手术周流体管理的机构方法.
主要方法:
- 在ERAS途径中对外科手术期间流体管理的现有文献的审查.
- 关于限制性与自由流体治疗方案的证据分析.
- 讨论液体给药和患者体重增加的临界值.
- 关于标准化流体管理的机构协议的介绍.
主要成果:
- 目前缺乏限制性和自由流体方案的标准化定义.
- 与其他液体参数相比,输液率 (mL/kg/h) 对术后结果的预测能力较低.
- 总静脉注射液体和患者体重增加的临界值被确定为结果的显著预测指标.
结论:
- 需要在ERAS中为外科手术期间流体管理提供标准化的定义和协议.
- 专注于静脉注射液体总容量和体重增加可能比输液率提供更具预测性的见解.
- 实施机构指导方针可以提高ERAS途径中的一致性和患者结果.
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