消化道穿孔围手术期液体治疗中的正平衡

目的 :探讨消化道穿孔 (DTP)急诊手术病例围手术期液体正平衡与APACHEⅡ评分的关系。方法 :根据APACHEⅡ评分 ,将连续 3 72例DTP病例分为轻症 ( <8分 )、重症 ( 8～ 19分 )和危重病例 (≥ 2 0分 ) 3组 ,比较 3组病例手术前、手术日和术后第 1日的液体正平衡量。结果 :轻症、重症和危重病例术前的液体正平衡量分别为 112 6.91± 414.80mL、2 3 60 .89± 85 7.0 3mL和 3 494.97± 995 .65mL(P <0 .0 1) ;手术日液体正平衡量分别为 2 10 3 .71± 72 8.99mL、40 5 0 .5 6± 10 3 6.3 7mL和 5 743 .95± 12 5 6.2 1mL(P <0 .0 1) ;术后第 1日液体正平衡量分别为 916.81± 5 5 9.62mL、12 11.43± 679.85mL和 15 87.0 9± 73 3 .3 8mL(P <0 .0 1)。结论 :无论是术前、手术当日或术后第 1日 ,DTP病例的液体正平衡量与其APACHEⅡ评分正相关。APACHEⅡ评分可估测DTP病例的液体正平衡量 ,指导其围手术期的液体治疗

The Positive Balance of Perioperative Fluid Therapy of Patients with Digestive Tract Perforation

Objective: To evaluate the relativity between perioperative positive fluid balance and APACHEⅡ score of the patients with digestive tract perforation, who underwent emergent laparotomy. Methods: According to APACHEⅡ score on admission, 372 consecutive patients with digestive tract perforation were divided into three groups: mild group (the score<8), severe group (the score 8～19) and critical group (the score≥20). The volumes of perioperative positive fluid balance were compared among three groups. Results: The volume of positive fluid balance of mild, severe and critical cases was respectively 1126.91± 414.80mL, 2360.89± 857.03mL and 3494.97± 995.65mL (P< 0.01) during preoperative phase, was respectively 2103.71± 728.99mL, 4050.56± 1036.37mL and 5743.95± 1256.21mL (P< 0.01) in operative day, was respectively 916.81± 559.62mL, 1211.43± 679.85mL and 1587.09± 733.38mL (P< 0.01) in the first day after emergent laparotomy. Conclusion: There is significant positive correlation between the volume of perioperative positive fluid balance and APACHE Ⅱ score of patients with digestive tract perforation. APACHEⅡ score can estimate the volume of perioperative positive fluid balance and direct fluid therapy of the patients with digestive tract perforation.