限制補液策略有利于結直腸癌伴糖尿病患者術后的早期安全康復_《中國普外基礎與臨床雜志》

作者：

李蔚 ^1,2,3 , 肖凌 ^1,2,3 , 余曦 ^1,2,4 , 汪曉東 ^1,2 , 李立 ^1,2

1.四川大學華西醫院胃腸外科中心(成都 610041);;
2.四川大學華西醫院MCQ團隊(成都 610041);;
3.四川大學華西口腔醫學院(成都 610041);;
4.四川大學華西臨床醫學院(成都610041);

關鍵詞：

液體管理糖尿病結直腸腫瘤快速流程

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　目的　探究限制補液策略對結直腸癌伴糖尿病患者術后早期康復的臨床價值。
　方法　回顧性研究2007年1月至2009年10月期間四川大學華西醫院結直腸外科專業組收治的伴糖尿病的結直腸癌患者的臨床資料，分析比較采用不同補液方案(限制補液組和常規補液組)的術后首次排氣、進食、下床活動及住院時間，術后早期并發癥(傷口感染、吻合口漏、腸梗阻)，生化與血常規檢查指標(血紅蛋白、白細胞計數、葡萄糖、尿素氮)。
　結果　限制補液組術后首次排氣及下床活動時間均早于常規補液組(P lt;0.05)，而2組術后首次進食、術后住院時間的差異無統計學意義(P gt;0.05)。在術后早期并發癥方面，限制補液組的傷口感染率明顯低于常規補液組(P lt;0.05)，而2組間吻合口〖漏及腸梗阻發生率差異無統計學意義(P gt;0.05)。生化與血常規檢查指標，術前2組患者各指標的差異均無統計學意義(P gt;0.05)；術后限制補液組葡萄糖水平明顯低于常規補液組(P lt;0.05)，其余指標2組間差異無統計學意義(P gt;0.05)。
　結論　術后限制補液策略可以降低伴糖尿病的結直腸癌患者術后常見并發癥的發生率并有利于患者的康復。

引用本文： 李蔚,肖凌,余曦,汪曉東,李立. 限制補液策略有利于結直腸癌伴糖尿病患者術后的早期安全康復. 中國普外基礎與臨床雜志, 2010, 17(4): 399-403. doi: 復制

1.	Schwenk W, Haase O, Raue W, et al. Establishing “fast track” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129(6): 502-509.
2.	劉展, 汪曉東, 李立. 多學科協作診治模式下的結直腸外科快速康復流程 [J]. 中國普外基礎與臨床雜志, 2007; 14(2): 239-242.
3.	Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 1812-1818.
4.	肖凌, 黃真真, 李蔚, 等. 快速流程模式中術后限制補液在老年結直腸癌患者中的應用價值 [J]. 中國普外基礎與臨床雜志, 2010; 17(1): 87-91.
5.	Bower WF, Lee PY, Kong AP, et al. Peri-operative hyperglycemia: a consideration for general surgery? [J]. Am J Surg, 2010; 199(2): 240-248.
6.	吳在德, 吳肇漢. 外科學 [M]. 第7版. 北京: 人民衛生出版社, 2008: 66.
7.	Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323-332.
8.	呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀 [J]. 中國普外基礎與臨床雜志, 2007; 14(6): 713-716.
9.	Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355-360.
10.	Dronge AS, Perkal MF, Kancir S, et al. Long-term glycemic control and postoperative infectious complications [J]. Arch Surg, 2006; 141(4): 375-380.
11.	Chung YW, Han DS, Park KH, et al. Insulin therapy and colorectal adenoma risk among patients with type 2 diabetes mellitus: a case-control study in Korea [J]. Dis Colon Rectum, 2008; 51(5): 593-597.
12.	Christopherson K. The impact of diabetes on wound healing: implications of microcirculatory changes [J]. Br J Community Nurs, 2003; 8(12): S6-S13.
13.	Mousley M. Diabetes and its effect on wound healing and patient care [J]. Nurs Times, 2003; 99(42): 70, 73-74.
14.	Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405-409.
15.	von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1-E7.
16.	Lobo DN, Bjarnason K, Field J, et al. Changes in weight, fluid balance and serum albumin in patients referred for nutritional support [J]. Clin Nutr, 1999; 18: 197-201.
17.	Mller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 57-62.
18.	MacKay G, Fearon K, McConnachie A, et al. Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 1469-1474.
19.	Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601-605.
20.	Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 1504-1509.
21.	Wellby ML, Kennedy JA, Barreau PB, et al. Endocrine and cytokine changes during elective surgery [J]. J Clin Pathol,1994; 47(11): 1049-1051.
22.	Desborough JP. The stress response to surgery [J]. Br J Anaesth, 2000; 85(1): 109-117.
23.	Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier. Role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477-490.
24.	Rahbari NN, Zimmermann JB, Schmidt T, et al. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331-341.
25.	Brandstrup B, Tnnesen H, Beier-Holgersen R, et al. Eff-ects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg, 2003; 238(5): 641-648.

1. 　Schwenk W, Haase O, Raue W, et al. Establishing “fast track” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129(6): 502-509.
2. 　劉展, 汪曉東, 李立. 多學科協作診治模式下的結直腸外科快速康復流程 [J]. 中國普外基礎與臨床雜志, 2007; 14(2): 239-242.
3. 　Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 1812-1818.
4. 　肖凌, 黃真真, 李蔚, 等. 快速流程模式中術后限制補液在老年結直腸癌患者中的應用價值 [J]. 中國普外基礎與臨床雜志, 2010; 17(1): 87-91.
5. 　Bower WF, Lee PY, Kong AP, et al. Peri-operative hyperglycemia: a consideration for general surgery? [J]. Am J Surg, 2010; 199(2): 240-248.
6. 　吳在德, 吳肇漢. 外科學 [M]. 第7版. 北京: 人民衛生出版社, 2008: 66.
7. 　Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323-332.
8. 　呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀 [J]. 中國普外基礎與臨床雜志, 2007; 14(6): 713-716.
9. 　Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3): 355-360.
10. 　Dronge AS, Perkal MF, Kancir S, et al. Long-term glycemic control and postoperative infectious complications [J]. Arch Surg, 2006; 141(4): 375-380.
11. 　Chung YW, Han DS, Park KH, et al. Insulin therapy and colorectal adenoma risk among patients with type 2 diabetes mellitus: a case-control study in Korea [J]. Dis Colon Rectum, 2008; 51(5): 593-597.
12. 　Christopherson K. The impact of diabetes on wound healing: implications of microcirculatory changes [J]. Br J Community Nurs, 2003; 8(12): S6-S13.
13. 　Mousley M. Diabetes and its effect on wound healing and patient care [J]. Nurs Times, 2003; 99(42): 70, 73-74.
14. 　Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405-409.
15. 　von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1-E7.
16. 　Lobo DN, Bjarnason K, Field J, et al. Changes in weight, fluid balance and serum albumin in patients referred for nutritional support [J]. Clin Nutr, 1999; 18: 197-201.
17. 　Mller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 57-62.
18. 　MacKay G, Fearon K, McConnachie A, et al. Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 1469-1474.
19. 　Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg, 2005; 101(2): 601-605.
20. 　Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 1504-1509.
21. 　Wellby ML, Kennedy JA, Barreau PB, et al. Endocrine and cytokine changes during elective surgery [J]. J Clin Pathol,1994; 47(11): 1049-1051.
22. 　Desborough JP. The stress response to surgery [J]. Br J Anaesth, 2000; 85(1): 109-117.
23. 　Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier. Role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477-490.
24. 　Rahbari NN, Zimmermann JB, Schmidt T, et al. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331-341.
25. 　Brandstrup B, Tnnesen H, Beier-Holgersen R, et al. Eff-ects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg, 2003; 238(5): 641-648.

《中國普外基礎與臨床雜志》

限制補液策略有利于結直腸癌伴糖尿病患者術后的早期安全康復

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《中國普外基礎與臨床雜志》

限制補液策略有利于結直腸癌伴糖尿病患者術后的早期安全康復

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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