大腹部手术中静脉输液的选择:系统综述

IF 1.8 Q3 CRITICAL CARE MEDICINE
Critical Care Research and Practice Pub Date : 2020-08-03 eCollection Date: 2020-01-01 DOI:10.1155/2020/2170828
Seechad Noonpradej, Osaree Akaraborworn
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引用次数: 5

摘要

背景:手术中静脉输液治疗对维持组织灌注和电解质止血的血流动力学状态起着重要作用。最近对危重病人的试验报告了某些类型的液体的严重副作用。由于最合适的液体类型是有争议的,围手术期患者尚未达成共识。方法:我们对比较腹部大手术中两种或两种以上液体的随机对照试验(rct)进行了系统回顾。结果与出血、血流动力学状态、住院时间和并发症有关,如肾损伤、电解质异常、主要心脏不良事件、恶心、呕吐和死亡率。使用Medline和EMBASE进行文献检索,直至2019年12月。将这些数据进行汇总,以研究液体对大循环和血管内容积效应的影响。结果:纳入43项随机对照试验。对18种液体进行了比较:9种为晶体,9种为胶体。结果分为大循环和血管内容积效应、微循环、抗炎参数、血管通透性、肾功能(胶体)、肾功能和电解质(晶体)、凝血和出血、肠功能恢复和术后恶心呕吐(PONV)。我们发现没有特定类型的液体导致死亡,每种类型的胶体在体积膨胀上是相等的,并且不会引起肾损伤。然而,羟乙基淀粉和右旋糖酐可能导致出血增加。生理盐水可引起肾损伤,导致肾替代治疗,葡萄糖液可降低PONV。结论:我们认为,使用平衡的晶体作为维持液,使用胶体(如HES130/0.4、4%明胶或人白蛋白)作为体积膨胀剂是安全的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review.

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review.

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review.

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review.

Background: Intravenous fluid therapy plays a role in maintaining the hemodynamic status for tissue perfusion and electrolyte hemostasis during surgery. Recent trials in critically ill patients reported serious side effects of some types of fluids. Since the most suitable type of fluid is debatable, a consensus in perioperative patients has not been reached.

Method: We performed a systematic review of randomized control trials (RCTs) that compared two or more types of fluids in major abdominal surgery. The outcomes were related to bleeding, hemodynamic status, length of hospital stay, and complications, such as kidney injury, electrolyte abnormality, major cardiac adverse event, nausea, vomiting, and mortality. A literature search was performed using Medline and EMBASE up to December 2019. The data were pooled to investigate the effect of fluid on macrocirculation and intravascular volume effect.

Results: Forty-three RCTs were included. Eighteen fluids were compared: nine were crystalloids and nine were colloids. The results were categorized into macrocirculation and intravascular volume effect, microcirculation, anti-inflammatory parameters, vascular permeability, renal function (colloids), renal function and electrolytes (crystalloids), coagulation and bleeding, return of bowel function, and postoperative nausea vomiting (PONV). We found that no specific type of fluid led to mortality and every type of colloid was equivalent in volume expansion and did not cause kidney injury. However, hydroxyethyl starch and dextran may lead to increased bleeding. Normal saline can cause kidney injury which can lead to renal replacement therapy, and dextrose fluid can decrease PONV.

Conclusion: In our opinion, it is safe to give a balanced crystalloid as the maintenance fluid and give a colloid, such as HES130/0.4, 4% gelatin, or human albumin, as a volume expander.

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来源期刊
Critical Care Research and Practice
Critical Care Research and Practice CRITICAL CARE MEDICINE-
CiteScore
3.60
自引率
0.00%
发文量
34
审稿时长
14 weeks
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