摘要
目的评价神经外科肿瘤切除术患者应用不同晶体液对血清晶体渗透压、电解质、乳酸及血糖的影响。方法择期行幕上肿瘤切除术患者60例,年龄18~64岁,ASAⅠ或Ⅱ级,随机分为三组（n=20）：乳酸钠林格氏液组（L组）、生理盐水组（N组）、醋酸钠林格氏液组（P组）。三组患者诱导前按照体质量×3 mL输注6%羟乙基淀粉（130/0.4）,诱导后以每小时生理需要量分别输注乳酸钠林格氏液、生理盐水、醋酸钠林格氏液至麻醉结束,以每搏输出量变异度（SVV）指导输注6%羟乙基淀粉（130/0.4）。分别于麻醉诱导前（T1）、剪硬膜即刻（T2）、术毕（T3）测定动脉血气、电解质、乳酸、血糖、ALT、AST、肌酐及尿素,计算血清晶体渗透压值。记录上述不同时点血液动力学指标、术中液体出入情况、患者ICU停留时间及术后住院时间。结果三组患者手术时间、麻醉时间、术中液体总量、晶体液量、胶体液量、失血量、尿量、乳酸、AST、ALT、肌酐及尿素、ICU停留时间及术后住院时间比较无显著性差异（P〉0.05）;与L组比较,N组和P组T2时点Na＋浓度、血清晶体渗透压升高（P〈0.05）;P组T2、T3时点血糖较N组和L组降低（P〈0.05）;与N组比较,P组T2、T3时点氯离子的浓度降低（P〈0.05）。结论醋酸钠林格氏液可避免生理盐水导致的氯离子浓度升高和乳酸钠林格氏液导致的血清晶体渗透压降低,且不升高血糖,更适合神经外科手术患者术中输注。
[ Objective ] To investigate the effects of different crystalloid solution on serum osmolality, electrolytes lactate and blood glucose in patients undergoing intracranial tumor resection. [ Methods ] Sixty patients aged 18-64 and ASA I or II are admitted for an elective operation of supratentorial tumor and randomly divided into three groups （n =20 for each group）： lactated Ringer＇s solution group （group L）, normal saline group（group N） and acetated Ringerls sodium group （group P）. Patients of three groups are received kgx3 mL Hydroxyethy! starch 6% therapy be- fore induction. Subsequently, three groups respectively fixed rate of physical requirement＇h crystalloid, including lactated Ringer＇s solution, normal saline or acetated Ringer/s sodium, to the end of the anesthesia. Arterial blood gas analysis was performed before induction of anesthesia （T1）, before dural opening （T2） and end of operation （T3）. Arte- rial blood sample are taken to detect electrolytes, lactic acid , blood glucose, aspartate aminotransferase, Alanine amino transferase, creatinine, urea nitrogen and calculate serum osmolality at T1-3. [ Results ] There were no signifi- cant differences in the time of operation and anesthesia, fluid volume, blood loss and urine volume. The patients re- ceiving lactated Ringer＇s solution had significantly decreased serum osmolality and sodium concentrations at T2 （P 〈0.05） compared to those receiving normal saline or Plasmalyte. The patients receiving Plasmalyt had significantly de- creased blood glucose concentrations at T2,3（P 〈0.05） compared to those receiving lactated Ringer＇s solution or normal saline. The patients receiving normal saline had significantly increased chloride concentrations at T23 （P 〈0.05） com- pared to those receiving lactated Ringer＇s solution or Plasmalyte. [ Conclusions ] Plasmalyte which can avoid in- creased chloride concentrations receiving normal saline and decreased serum osmolality receiving lactated Ringer＇s solution as well as not rising blood glucose is more suitable for patients undergoing intracranial tumor resection.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2014年第3期92-96,共5页
China Journal of Modern Medicine
