限制性液体治疗对重度功能性便秘术后康复的影响.docVIP

  限制性液体治疗对重度功能性便秘术后康 复的影响# 张娟娟1,2，虞文魁1,2** 5 10 15 20 25 30 35 40 （1. 南京大学医学院临床学院； 2. 解放军普通外科研究所，江苏南京 210002） 摘要：目的：围手术期液体治疗往往使体重增加 3-6kg，有报道结直肠术后有 68%的病人会 发生并发症。最近研究表明限制性液体治疗可以改善胃肠大手术预后。本研究观察限制性液 体治疗和常规液体治疗对重度功能性便秘术后康复的影响。方法：将 2006 年 10 月~2008 年 1 月因重度功能性便秘需手术治疗的病人随机分为两组，分别进行常规液体治疗(常规组/S 组，n＝36)和限制性液体治疗(限制组/R 组，n＝37)。与常规组相比，限制组不常规补充手 术麻醉引起血管扩张所要补充的液体量和围手术期第三间隙丢失量。观察两组液体治疗后住 院时间、肠功能恢复时间、并发症、死亡率等的差异。结果：限制性液体治疗组手术期间输 注的液体量明显减少(p=0.001)，以晶体量减少为主(p0.001)。与常规组相比，术后并发症发 生率减少〔9 例(24.3%)vs 15 例(41.7%)〕，其中全身并发症明显减少〔7 例(18.9%)vs13 例 (36.1%)，p=0.100〕，术后平均肠功能恢复时间明显缩短(2 天 vs4 天，p=0.049)，平均住院 时间显著减少(10 天 vs13 天，p=0.041)。结论：限制性液体治疗减少重度功能性便秘术后并 发症，缩短住院时间，加速病人康复。 关键词：限制性液体治疗；重度功能性便秘；金陵术；并发症 Effects of Perioperative Fluid Restriction After Opration for Severe functional constipation Zhang Juanjuan1, Yu Wenkui2 (1. Department of surgery,Jinling Hospital,Nangjing Univercity School of Medicine,Nanjing,210002,China; 2. Department of surgery,Jinling Hospital,Nanjing Univercity School of Medicine,Nanjing,210002,China) Abstract: Objective: Current fluid administration in major surgery causes a weight increase of 3–6 kg. Complications after colorectal surgery are reported in up to 68% of patients. Recent evidence suggests that restricted perioperative fluid therapy improves outcome after major elective gastrointestinal surgery. To investigate the effects of intravenous fluid restriction on rehabilitation after modified Duhamel operation for severe functional constipation. Methods: Seventy-three patients admitted for severe functional constipation operation were randomized to a standard (S,n=36) or restricted (R,n=37) fluid regimen. To investigate diffenerces of hospital stay 、 recovery time of enteric function and complications. Results: After restricted fluid regimen perioperative intravenous fluid volume was significantly reduced（p=0.001）,especially crystalloid solution(p=0.001).Compared with standard group, the incidence of postoperative complications was reduced in the restricted gr