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首页> 外文期刊>Anaesthesia and intensive care >A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program.
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A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program.

机译：与选择性食管大肠手术中食管多普勒引导的目标导向输液治疗相比，输液受限的随机对照试验在增强的术后恢复程序范围内。

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There is continued controversy regarding the benefits of goal-directed fluid therapy, with earlier studies showing marked improvement in morbidity and length-of-stay that have not been replicated more recently. The aim of this study was to compare patient outcomes in elective colorectal surgery patients having goal-directed versus restrictive fluid therapy. Inclusion criteria included suitability for an Enhanced Recovery After Surgery care pathway and patients with an American Society of Anesthesiologists Physical Status score of 1 to 3. Patients were intraoperatively randomised to either restrictive or Doppler-guided goal-directed fluid therapy. The primary outcome was length-of-stay; secondary outcomes included complication rate, change in haemodynamic variables and fluid volumes. Compared to restrictive therapy, goal-directed therapy resulted in a greater volume of intraoperative fluid, 2115 (interquartile range 1350 to 2560) ml versus 1500 (1200 to 2000) ml, P=0.008, and was associated with an increase in Doppler-derived stroke volume index from beginning to end of surgery, 43.7 (16.3) to 54.2 (21.1) ml/m(2), P <0.001, in the latter group. Length-of-stay was similar, 6.5 (5 to 9) versus 6 (4 to 9) days, P=0.421. The number of patients with any complication (minor or major) was similar; 0% (30) versus 52% (26), P=0.42, or major complications, 1 (2%) versus 4 (8%), P=0.36, respectively. The increased perioperative fluid volumes and increased stroke volumes at the end of surgery in patients receiving goal-directed therapy did not translate to a significant difference in length-of-stay and we did not observe a difference in the number of patients experiencing minor or major complications.
机译：关于目标导向输液治疗的益处仍存在争议，早期研究显示发病率和持续时间有显着改善，这一点在最近没有得到证实。这项研究的目的是比较目标导向和限制性液体疗法的选择性结直肠手术患者的结果。入选标准包括手术后护理路径增强的适应性以及美国麻醉医师学会身体状况评分为1到3的患者。患者在术中随机接受限制性或多普勒引导的目标定向输液治疗。主要结果是住院时间;次要结果包括并发症发生率，血液动力学变量的变化和体液量。与限制性疗法相比，以目标为导向的疗法导致术中液体量更大，为2115（四分位间距1350至2560）毫升，而1500（1200至2000）毫升，P = 0.008，并且与多普勒血流的增加从手术开始到结束的每搏输出量指数，在后一组中为43.7（16.3）至54.2（21.1）ml / m（2），P <0.001。住院时间相似，分别为6.5（5至9）天和6（4至9）天，P = 0.421。患有任何并发​​症（轻微或严重）的患者人数相似; 0％（30）对52％（26），P = 0.42，或重大并发症，1（2％）对4（8％），P = 0.36。接受目标导向治疗的患者在手术结束时围手术期液体量的增加和中风量的增加并未导致住院时间的显着差异，并且未观察到经历过轻度或重度患者的人数差异并发症。

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