Intraoperative Flüssigkeitstherapie bei Pankreasresektionen - Die Sicht des Chirurgen

Zusammenfassung

Obwohl die intra- und perioperative Infusionstherapie bei großen chirurgischen Eingriffen in der Vergangenheit mehrfach thematisiert wurde, bestehen nach wie vor keine Evidenz-basierten Empfehlungen zu Art und Menge der empfohlenen Infusionslösungen. Der vorliegende Beitrag erläutert die Thematik aus Sicht des Chirurgen. Für den Chirurgen sind vor allem der Einfluss größerer Flüssigkeitsmengen auf Wund- und Anastomosenheilung, Blutungskomplikationen sowie den postoperativen Verlauf (Extubationszeitpunkt, postoperative Darmfunktion, Krankenhausverweildauer, usw.) von Interesse. Zur Klärung der Frage, wie eine aus chirurgischer Sicht anzustrebende intraoperative Infusionstherapie beschaffen sein sollte, werden Angaben aus der Literatur und eigene Daten herangezogen. Die retrospektive Analyse von 98 Pankreasresektionen an unserer Klink ergab keine signifikanten Unterschiede bezüglich der Häufigkeit von Nachblutung (8,2 %), Wundheilungsstörung (4,1 %), Pankreasfisteln (9,4 %) und Mortalität (2,0 %) in Abhängigkeit von der Flüssigkeitsgabe. Die Komplikationsrate war vergleichbar mit der anderer Autoren. Die durchschnittliche Infusionsmenge betrug 13,9 ± 0,9 mL / kg / h. In 74 % aller Operationen wurden Katecholamine und in 54 % Noradrenalin appliziert. Auch wenn diese Qualitätsmessgrößen weiteren Variablen unterworfen sind, lässt sich anhand dieser Ergebnisse ableiten, dass die intraoperative Gabe von 10-15 mL / kg / h keinen negativen Einfluss auf das Outcome nach Pankreasresektionen hat und sich somit die intraoperative Volumentherapie an diesen Werten orientieren sollte.

Abstract

Even though intraoperative fluid management during major intraabdominal surgery has frequently been addressed in the past, there is a lack of evidence-based recommendations. This report elucidates the topic from the surgeon's view. For the surgeon, the influence of larger fluid amounts on wound and anastomotic healing, bleeding complications and postoperative outcome (time of extubation, postoperative gastrointestinal function, hospital stay, etc.) is of interest. To clarify the question as to what a perioperative fluid regime should be composed of from a surgical point of view, data from the literature and our own studies were evaluated. The retrospective analysis of 98 pancreas resections that had been performed in our hospital revealed no significant differences concerning the occurrence of postoperative bleeding (8.2 %), wound infection (4.1 %), pancreatic fistula (9.4 %) and mortality (2.0 %) based on the administered intraoperative fluid amount. These results were comparable to those of other authors. The average intraoperatively infused fluid amount was 13.9 ± 0.9 mL / kg / h. Catecholamines were administered in 74 % of all operations, while noradrenaline was used in 54 % of all cases. Although other factors might play a role in this setting, we can deduce from these data that application of a volume of 10-15 mL / kg / h has no negative influence on the outcome following pancreas resections and that the intraoperative fluid therapy should be targeted at these values.

Schlüsselwörter

intraoperative Flüssigkeitstherapie - Pankreas - Chirurgie - Komplikationen - Pankreasfistel

Key words

intraoperative fluid management - pancreas - surgery - complications - pancreatic fistula

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