Background

Sufficient tissue oxygen tension may reduce the risk of postoperative wound infections. Supplemental administration of crystalloids increases subcutaneous oxygen tension (P_sqo₂). Colloids remain longer in the intravascular system and might therefore increase P_sqo₂ even more than crystalloids. Therefore, we tested the hypothesis that goal-directed colloid administration increases the perioperative P_sqo₂ more compared with crystalloid administration.

Methods

We randomly assigned 80 patients undergoing elective open abdominal surgery to receive fluid boluses of hydroxyethyl starch (HES) or lactated Ringer's (LR) solution guided by oesophageal Doppler. Intraoperative P_sqo₂ was measured in the upper arm. After operation, we measured the P_sqo₂ in the upper arm and in the surgical wound.

Results

Forty patients were enrolled in each group. Patients in the colloid group received HES solution 750 ml (500; 1000) and LR solution 1500 ml (1000; 2000). Patients in the crystalloid group received LR solution 2825 ml (2000; 3960). The goal-directed administration of colloids did not improve intraoperative P_sqo₂ in the arm compared with crystalloid administration (11.4 kPa [9.0; 16.6] vs 11.2 kPa [8.6; 15.1], respectively; P=0.58). Postoperative arm P_sqo₂ was 8.1 kPa (6.5; 9.6) in the colloid group and 7.3 kPa (5.7; 9.1) in the crystalloid group (P=0.11). Postoperative surgical wound P_sqo₂ was 10.7 kPa (8.6; 13.4) in the colloid group and 10.1 kPa (8.1; 12.7) in the crystalloid group (P=0.68).

Conclusions

Goal-directed colloid administration did not increase P_sqo₂ compared with goal-directed crystalloid administration in patients undergoing open abdominal surgery.

Clinical trial registration

NCT00517127.

中文翻译：

---

基于目标的晶体对胶体液策略对组织氧张力的影响：一项随机对照试验

背景

足够的组织氧张力可以降低术后伤口感染的风险。补充晶状体可增加皮下氧气张力（P _sq o ₂）。胶体在血管内系统中保留的时间更长，因此，P _sq o _2的增加甚至可能比晶体中的增加。因此，我们测试了一种假设，即与胶体注射相比，靶向胶体注射可增加围手术期的P _sq o ₂。

方法

我们随机分配80例接受选择性开放腹部手术的患者，接受食管多普勒引导下的羟乙基淀粉（HES）或乳酸林格氏（LR）溶液输注。术中在上臂测量P _sq o ₂。手术后，我们测量了上臂和手术伤口中的P _sq o ₂。

结果

每组四十名患者入组。胶体组的患者接受750 ml（500; 1000）的HES溶液和1500 ml（1000; 2000）的LR溶液。晶体组患者接受LR溶液2825 ml（2000; 3960）。与晶体给药相比，以胶体为目标的给药不会改善臂内术中的P _sq o ₂（分别为11.4 kPa [9.0; 16.6] vs 11.2 kPa [8.6; 15.1]；P = 0.58）。胶体组的术后臂P _sq o ₂为8.1 kPa（6.5; 9.6），晶体组的为7.3 kPa（5.7; 9.1）（P = 0.11）。手术后伤口P _sq o₂在胶体组中为10.7 kPa（8.6; 13.4），在晶体组中为10.1 kPa（8.1; 12.7）（P = 0.68）。

结论

在进行开腹手术的患者中，与按目标定向的胶体给药相比，按目标定向的胶体给药不会增加P _sq o ₂。

临床试验注册

NCT00517127。