摘要
目的观察液体治疗的剂量对择期腹部手术病人的影响。方法以2014年1月1日至2016年1月1日接受择期腹部手术后入住华北理工大学附属医院ICU>48 h的病人为研究对象,进行病例对照研究。采集病人的人口学数据、手术相关资料以及临床结局指标。将术后ICU滞留是否超过5 d界定为延时ICU住院组或非延时ICU住院组。先后采用单因素分析和多元回归分来评估影响择期腹部手术病人术后延时ICU住院的独立危险因素。结果该研究共纳入186例病人,年龄(68.1±13.5)岁,其中延时ICU住院病人占38.71%,通过分析发现术中液体平衡量是影响病人临床预后的独立危险因素[OR=1.027,95%CI(1.009～1.043),P<0.005],当术中液体正平衡>2 000 mL时,术后机械通气时间[(5.25±3.18)d比(2.62±3.26)d,P<0.001]、术后ICU住院时间[(3.05±2.07)d比(7.05±4.16)d,P<0.001]、术后住院时间[(16.37±4.91)比(12.85±5.37)d,P<0.001]明显延长,病人术后心血管并发症(32.31%比10.73%,P<0.001)、消化系统并发症(26.15%发生率也明显升高。结论在择期腹部手术中液体过负荷会增加病人术后ICU病死率及住院病死率,延长病人术后机械通气时间、术后ICU住院时间及术后住院时间,增加病人术后并发症(心血管、呼吸系统、消化系统)发生率,而液体治疗的类型对高危手术病人临床预后无明显影响。
Objective To observe the effect of volume of fluid therapy on the outcomes in elective abdominal surgeries in a retrospective case-control study.Methods We conducted a retrospective case-control study in patients with ICU >48 h in the Affiliated Hospital of North China University of Science and Technology after receiving elective open abdominal surgery from January 1,2014 to January 1,2016.The patient's demographic data,surgical-related data and clinical outcome indicators were collected.The postoperative ICU retention > 5 d was defined as delayed ICU hospitalization group and the others were designed as non-ICU delayed hospitalization group. We used univariate analysis and multiple regression analysis to assess the independent risk factors of ICU hospitalization in patients with elective abdominal surgery. Result A retrospective case-control study was conducted on 186 patients with elective abdominal surgeries who met the inclusion riteria. We found that intraoperative fluid balance was an independent risk factor for the clinical outcomes(OR= 1.027,95% CI 1.009 to 1.043,P < 0.005).When intraoperative fluid balance > 2000 mL,postoperative mechanical ventilation time(5.25 ± 3.18 vs. 2.62 ± 3.26,P < 0.001),postoperative ICU hospitalization time(3.05 ±2.07 vs.7.05± 4.16, P< 0.001) and postoperative hospitalization time(16.37±4.91 vs.12.85±5.37,P< 0.001)) were sufficiently longer than others, postoperative cardiovascular complications rate(32.31 % vs. 19.83%, P < 0.05), the respiratory complications rate(26.15% vs. 12.40%, P < 0.05) and the incidence of infections(29.23% vs. 14.05%, P < 0.05) were also significantly higher than others, but the postoperative 24 h urine output, acute renal insufficiency and neurological complications rate were not significantly different between the two groups. Conclusion For the elective open abdominal surgeries, the fluid overload will increase the postoperative ICU and hospital mortality,prolong the postoperative mechanical ventilation time,ICU hospitalization time and total hospitalization time, increase the postoperative complications rate(cardiovascular system, respiratory system and digestive system), however, the types of fluid therapy has no significant effect on the clinical outcomes of patients with high risk surgery.
引文
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