关键词: 肺部并发症, 液体治疗, 围手术期

Abstract:

Perioperative fluid therapy and postoperative respiratory complications        YU Wen-kui. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, Medical College of Nanjing University, Nanjing 210002, China
Abstract    Postoperative pulmonary complications (PPCs) frequently result in serious morbidity and mortality. Recent evidence suggests that judicious perioperative fluid therapy reduces PPCs after major elective gastrointestinal surgery. The observed benefits may not be solely attributable to crystalloid restriction but also to the use of colloids instead. Some clinically useful guidelines include elimination of preload for patients who receive epidural analgesia. A balanced approach to fluid management is recommended, with colloids administered to provide hemodynamic stability and maintain urine output of 0.5mL/(kg·h）and crystalloids administered only for maintenance. Blood loss may be replaced with colloid on a volume-to-volume basis. In addition, predetermined algorithms that suggest replacement of third space losses and losses through diuresis are unnecessary. Furthermore, close monitoring of serum lactate levels with adjustment of intravenous fluid administration intraoperatively and in the early postoperative period may improve the early detection and correction of inadequate tissue perfusion. Finally, there is a need for more well-controlled studies in a well defined patient population using clear criteria or endpoints for perioperative fluid therapy.

Key words: pulmonary complications, fluid therapy, preoperative peroid