围手术期输注液体与肝脏术后感染的探讨

Relationship between perioperative fluid infusion and complication of infections after liver surgery

目的前瞻性分析100例肝脏手术患者围手术期液体治疗与术后感染并发症发生率的关系,探讨围手术期液体治疗的策略及发展方向。方法将100例肝脏手术患者根据围手术期接受开放性和限制性液体治疗策略分为开放组和限制组,各50例,围手术期限制组用乳酸林格氏液按4ml/(kg·h)的速度静脉滴入进行液体治疗,开放组开腹前按10ml/(kg·h),开腹后加快静脉滴入速度至12ml/(kg·h)并维持至手术结束,对两组患者感染并发症发生率、免疫情况、炎性指标等进行比较。结果限制组患者手术部位感染4例次,明显低于开放组,肺炎发生率和尿道感染率开放组也显著高于限制组,术后机体免疫变化:CD4+/CD8+比值限制组术前术后差异更小,CRP限制组术后的平均值也更小,术后恢复方面,限制组患者术后平均肛门排气时间明显较短,差异有统计学意义(P<0.05)。结论肝脏手术围手术期采用不同的液体治疗策略与术后感染并发症发生有关,早期目标指导治疗是围手术期液体治疗的一个发展方向。

OBJECTIVE To prospectively analyze the correlation between the perioperative liquid infusion therapy and the incidence of postoperative infections in 100 patients undergoing liver surgery and explore the strategies and development direction of the perioperative fluid therapy. METHODS A total of 100 patients who underwent the liver surgery were divided into the liberal fluid therapy group and the restricted fluid therapy group according to the perioperative fluid therapy strategies, with 50 cases in each; the restricted fluid therapy group was treated with intravenous administration of Ringerls lactate at a speed of 4 ml/（kg · h）, the liberal fluid therapy group was treated at a speed of 10 ml/（kg ·h） before laparotomy and at a seed of 12 ml/（kg ·h） after laparotomy till the end of surgery; the incidence of complication of infections, immunity, and inflammatory indicators were observed and com- pared between the two groups. RESULTS There were 4 case-times of surgical site infections in the restricted fluid therapy group, significantly less than those in the liberal fluid therapy group; the incidence rates of pneumonia and urinary tract infections were significantly higher in the liberal fluid therapy group than in the restricted fluid therapy group. As compared with the change of postoperative immune status, there was smaller difference in the CD4 ^＋/ CD8^ ＋ ratio between before and after the surgery, and the average value was also smaller after the surgery. As compared with the postoperative recovery, the average time of anal exhaust of the patients in the restricted fluid therapy group was significantly shorter after the surgery than before the surgery（P〈0.05）. CONCLUSION The postoperative complication of infections is associated with the different fluid therapy strategies that are adopted during the perioperative period of liver surgery, and the early＇goal-directed therapy is a development direction of the perioperative fluid therapy.