胃肠道手术围手术期的液体管理

Perioperative fluid management in gastrointestinal surgery

胃肠道手术围手术期的体液管理是维持各脏器、组织和细胞足够的血流灌注及氧供的关键因素。不同的体液管理策略不同程度地影响着患者术后各系统并发症的发生率与病死率。经过系统性回顾文献我们发现，与传统的自由液体管理相比．嗣手术期采用限制性液体管理和目标导向的液体管理将使患者总体上获益。尤其是在心输出量（CO）、每搏量（SV）、每搏量变异度（SVV）、脉压变异度（PPV）和脉搏灌注变异指数（PVI）等动态预测机体容量反应性指标的指导下，个体化的目标导向液体管理更有助于患者在围手术期维持血流动力学的稳定、保证组织与器官充足的灌注与氧供，并降低嗣手术期并发症和缩短术后住院时间。此外，限制性液体管理可能带来的潜在的组织低灌注的风险需引起临床医生的关注。也需更多的进一步研究来探索如何在恰当的时间给予恰当的液体种类及合适的液体量，使组织器官在闱手术期的功能达到最佳状态。

Perioperative fluid management in gastrointestinal surgery is one of the key points to maintain sufficient blood perfusion and oxygen delivery for the organs, tissues and cells. Different strategies of fluid management have different influences on postoperative complications and mortality. After systematic review of related literature, we found that compared with the conventional liberal liquid administration, restricted liquid management and goal directed liquid management would benefit patients in general. With the guidance of cardiac output （CO）, stroke volume （SV）, stroke volume variation （SVV）, pulse pressure variation （PPV） and pulse perfusion variation index （PVI）, which can dynamically monitor the reactivity to volume, individualized goal-directed liquid management was more likely to maintain the perioperative hemodynamic stability, guarantee adequate tissue and organ blood perfusion and oxygen delivelT, reduce perioperative eomplications, and shorten the postoperative hospital stay. In addition, the potential risk of tissue hypoperfusion caused by restricted liquid nmnagement should draw the clinicians＇attention. More researches are needed to explore the right tinting, the appropriate type of liquid and the reasonable amount of liquid to maintain the best functional state of tissues and organs pefioperatively.