术中液体治疗对剖宫产患者术后并发症影响的前瞻性对照研究

Effects of different fluid therapies on postoperative complications of cesarean section:a randomized clinical trial

目的观察剖宫产术中液体量、液体种类对患者术后相关并发症的影响。方法选择剖宫产患者320例,采用随机数字表法将其分入限制性晶体组、限制性胶体组、开放性晶体组和开放性胶体组,每组80例,分别予限制性晶体液10 mL/kg、限制性胶体液10 mL/kg、开放性晶体液20 mL/kg和开放性胶体液20 mL/kg处理,术后随访患者产后出血、产后感染、肠梗阻发生率和不良反应总发生率,以及产后24 h内的出血量和首次排气时间。结果4组间产后出血、产后感染、肠梗阻发生率和产后不良反应总发生率的差异均无统计学意义(P值均>0.05)。限制性晶体组和限制性胶体组产后24 h内的出血量显著少于开放性胶体组(P值均<0.05)。限制性晶体组和开放性晶体组患者术后首次排气时间显著晚于开放性胶体组和限制性胶体组(P值均<0.05)。结论剖宫产术中予限制性胶体治疗可促进患者术后胃肠功能恢复,不增加术后出血量,可作为剖宫产手术的合理液体治疗方案。

Objective To observe the effects of liquid volume and liquid type on postoperative complications of cesarean section. Methods A total of 320 patients undergoing cesarean section were randomly divided into four groups （n = 80）. The restrictive crystals of 10 mg/kg, restrictive colloids of l0 mg/kg, open crystals of 20 mg/kg and open colloids of 20 mg/kg were given to the four groups, respectively. The incidence of postpartum hemorrhage, postpartum infection, intestinal obstruction and total adverse reaction were measured. The amount of bleeding within 24 hours after surgery and the first time to flatus were recorded. Results There were no significant differences in the incidence of postpartum hemorrhage, postpartum infection, intestinal obstruction or total adverse reaction between groups （all P^0.05）. The amount of bleeding within 24 hours after surgery in restrictive crystal group and restrictive colloid group were significantly less than that in open colloid group （both P〈0.05）. Restrictive crystal group and open crystal group had markedly shorter time to the first flatus after surgery than open colloid group and restrictive colloid （all P〈0.05）. Conclusion The restrictive colloid therapy in cesarean section can promote postoperative gastrointestinal function recovery and reduce the amount of postoperative bleeding. It may be used as a reasonable liquid treatment program for cesarean section. （Shanghai Med J, 2017, 40： 156-159）