限制性液体治疗对胆道手术后并发症的影响

目的 探讨限制性液体治疗对胆道手术后并发症的影响.方法 前瞻性分析2006年10月至2008年3月南京军区南京总医院收治的168例接受胆道手术患者的临床资料.所有患者于术前按照封闭信封法随机分成研究组(采用限制性液体治疗,85例)和对照组(采用常规液体治疗,83例).观察两组患者补液量的差异,比较两组患者术后全身并发症发生率、腹部并发症发生率、总体并发症发生率、肠道功能恢复时间、住院时间、病死率的差异.采用x2检验、t检验及Fisher确切概率法对数据进行分析.结果 研究组和对照组术中静脉补液总量的中位值分别为1450 ml和2420 ml,两组比较,差异有统计学意义(t=-5.067,P<0.05).研究组静脉晶体补充量的中位值为850 ml,显著少于对照组的1500 ml(t=-15.190,P<0.05).研究组术后全身并发症发生率和总体并发症发生率分别为9%(8/85)和19%(16/85),低于对照组的22%(18/83)和30%(25/83).两组患者全身并发症发生率比较,差异有统计学意义(x2=4.837,P<0.05).研究组肠道功能恢复时间和住院时间分别为2 d和9 d,显著短于对照组的4 d和12 d(t=-8.102,-2.003,P<0.05).研究组和对照组病死率分别为2%(2/85)和4%(3/83),两组比较,差异无统计学意义(P>0.05).结论 限制性液体治疗降低了胆道手术后并发症的发生率,缩短住院时间,促进患者的术后恢复.

Abstract：

Objective To investigate the effects of intravenous fluid restriction on complications after biliary surgery.Methods The clinical data of 168 patients who received biliary surgery at the Nanjing General Hospital of Nanjing Military Command from October 2006 to March 2008 were prospectively analyzed.All patients were randomly divided into test group(85 patients received fluid restriction treatment)and control group(83 patients received conventional treatment)by the sealed envelope method.The difference in the fluid volume between the 2groups was observed.Differences in systemic complication rate,local complication rate,general complication rate,time to bowl movement,length of hospital stay and mortality between the 2 groups were compared.All data were analyzed using the chi-square test,t test,Fisher exact test,Results The median total volumes of fluid in test group and control group were 1450 ml and 2420 ml,respectively,with significant difference between the 2 groups (t=-5.067,P<0.05).The median volumes of erystalloid solution in the test group was 850 ml,which was significantly lower than 1500 ml of the control group(t=-15.190,P<0.05).The postoperative systemic complication rate and general complication rate of the test group were 9%(8/85)and 19%(16/85),which were lower than 22%(18/83)and 30%(25/83)of the control group.There was a significant difference in the postoperative systemic complication rate between the test group and the control group(x2=4.837,P<0.05).The time to bowl movement and length of hospital stay were 2 days and 9 days in the restriction fluid group,which were significantly shorter than4 days and 12 days in the control group(t=-8.102,-2.003,P<0.05).The mortalities of test group and control group were 2%(2/85)and 4%(3/83),respectively,with no significant difference between the 2 groups(P>0.05).Conclusion Fluid restriction reduces the complication rate,shortens the length of hospital stay and accelerates recovery after biliary operation.

Effects of intravenous fluid restriction on complications after biliary surgery

Objective To investigate the effects of intravenous fluid restriction on complications after biliary surgery.Methods The clinical data of 168 patients who received biliary surgery at the Nanjing General Hospital of Nanjing Military Command from October 2006 to March 2008 were prospectively analyzed.All patients were randomly divided into test group(85 patients received fluid restriction treatment)and control group(83 patients received conventional treatment)by the sealed envelope method.The difference in the fluid volume between the 2groups was observed.Differences in systemic complication rate,local complication rate,general complication rate,time to bowl movement,length of hospital stay and mortality between the 2 groups were compared.All data were analyzed using the chi-square test,t test,Fisher exact test,Results The median total volumes of fluid in test group and control group were 1450 ml and 2420 ml,respectively,with significant difference between the 2 groups (t=-5.067,P<0.05).The median volumes of erystalloid solution in the test group was 850 ml,which was significantly lower than 1500 ml of the control group(t=-15.190,P<0.05).The postoperative systemic complication rate and general complication rate of the test group were 9%(8/85)and 19%(16/85),which were lower than 22%(18/83)and 30%(25/83)of the control group.There was a significant difference in the postoperative systemic complication rate between the test group and the control group(x2=4.837,P<0.05).The time to bowl movement and length of hospital stay were 2 days and 9 days in the restriction fluid group,which were significantly shorter than4 days and 12 days in the control group(t=-8.102,-2.003,P<0.05).The mortalities of test group and control group were 2%(2/85)and 4%(3/83),respectively,with no significant difference between the 2 groups(P>0.05).Conclusion Fluid restriction reduces the complication rate,shortens the length of hospital stay and accelerates recovery after biliary operation.