食管癌围术期液体管理对肺部并发症影响的回顾性队列研究

Effect of perioperative fluid management on postoperative pulmonary complications of esophagectomy:A retrospective cohort study

目的了解食管癌手术围术期液体管理对术后肺部并发症发生的影响,找出最佳的补液方案。方法选取2014年6~12月间四川大学华西医院胸外科行食管癌切除,胃代食管术的75例食管鳞癌患者进行回顾性队列研究。肺部并发症的界定采用修订后的Kroenke术后肺部并发症分级系统。将所有出现Ⅱ~Ⅳ级肺部并发症的患者作为肺部并发症组[n=13,男12例、女1例,年龄(64.62±8.64)岁],其他患者作为无并发症组[n=62,男50例、女12例,年龄(60.55±8.73)岁],对比组间各临床指标和围术期出入量的差距。结果并发症组与无并发症组组间相比,存在差异的指标包括术后输注白蛋白,术中净入量、总入量、术中公斤体重净入量、术中公斤体重总入量、术中公斤体重小时净入量、术中公斤体重小时总入量(术中输液速度)、术后1~3 d总入量、术后1~3 d公斤体重总入量。其中,术中输液速度和术后1~3 d总入量对于预测肺部并发症的截点值分别为12.07 ml/(kg·h)和178.57 ml/kg。结论术中补液速度和术后前3 d的补液量是影响术后肺部并发症发生的重要因素,为降低术后并发症发病率,术中输液速度最好不超过12.07 ml/(kg·h),术后前3 d补液不超过178.57 ml/kg。在此范围之内,适当增加补液量有助于改善患者体验。

Objective To evaluate the effect of perioperative fluid management on postoperative pulmonary complications （PPCs） of esophagectomy, and to find out the optimal scheme for perioperative fluid administration. Methods This retrospective cohort study enrolled 75 patients with esophageal squamous cell cancer who have received esophagectomy in West China Hospital from June to December 2014. We used the Kroenke＇s postoperative pulmonary complications classification system to define the PPCs. Patients with PPCs of grade Ⅱ-Ⅳ were considered as PPCs group （n=13, 12 males, 1 female, age of 64.62±8.64 years）, and others were considered as non-complication group （n=62, 50 males, 12 females, age of 60.55±8.73 years）. Intraoperative and postoperative fluid inputs and outputs as well as clinical characteristics between groups were compared. Results Between two groups, there was a great difference in postoperative albumin infusion, intraoperative fluid administration [net input, total input, net input/kg, total input/kg, net input/（kg·h） and total input/（kg·h）] and fluid input on the first postoerative 1–3 days （total input and total input/kg）. The cutoff value for total input/（kg·h） in operation and total input on the first 1–3 postoerative days was 12.07 ml/（kg·h） and 178.57 ml/kg, respectively. Conclusion The speed of fluid infusion in operation and total input on postoperative 1-3 days are most important influence factors of PPCs. The speed in operation should not exceed 12.07 ml/（kg·h） and the total input on postoperative 1-3 days should not exceed 178.57 ml/kg. Within this range, an appropriate increase in fluid volume can make patients feel better.