围手术期输注钠钾镁钙葡萄糖或乳酸钠林格液对肝脏酮体代谢的影响  

Two Crystalloid Solutions on Metabolism of Hepatic Ketone Body during Perioperative Period

作　　者：刘艳秋[1] 任益民[1] 安丽[1] 蒋柯[1] 曾丽[1] 

机构地区：[1]贵州医科大学附院麻醉科,贵州贵阳550004

出　　处：《贵州医科大学学报》2018年第1期49-52,共4页Journal of Guizhou Medical University

基　　金：贵州省科技厅联合基金[黔科合LH字(2015)7424号]

摘　　要：目的:比较围术期输注钠钾镁钙葡萄糖注射液和乳酸钠林格液对肝脏酮体代谢的影响。方法:妇科和骨科择期手术患者46例随机均分为输注钠钾镁钙葡萄糖注射液组(G组)和输注乳酸钠林格注射液组(R组),两组病人手术期间全程输注相应液体,术中维持血压基本稳定,在麻醉诱导前(T1)和手术结束时(T2)采集动脉血检测血糖、乙酰乙酸、β-羟丁酸浓度,计算血酮体比率(乙酰乙酸/β-羟丁酸,KBR)及总酮体浓度。结果:G组T1时点血糖水平高于R组,T2时点乙酰乙酸、总酮体水平低于R组,R组T1时点乙酰乙酸、总酮体水平低于T2时点,差异有统计学意义(P<0.05);G组与R组T1和T2时点KBR比较,差异无统计学意义(P>0.05)。结论:围术期对手术患者输注两种晶体液对肝脏酮体代谢均无影响,但钠钾镁钙葡萄糖注射液可减少脂肪分解产生酮体。Objective： To compare the effect of sodium potassium magnesium calcium glucose or sodium lactate Ringer＇s solution on metabolism of hepatic ketone body during the perioperative period. Method： 46 patients with gynecological and orthopedic selective operation were randomly divided into the sodium potassium magnesium calcium glucose injection group （ G group） and sodium lactate Ringer injection group （ R group）, and two groups of patients were transfused with the corresponding liquid and maintained the basic stability of blood pressure during the operation. Arterial blood glucose, acetoacetate and concentration of 13-bydroxybutyrate were collected, and the ratio of blood ketone body ratio （acetoacetic acid/13-hydroxybutyrate, KBR） and the concentration of total ketone bodies were calcu- lated before induction of anesthesia （ T1 ） and at the end of surgery （T2）. Results ： The level of blood glucose at T1 time point in G group was higher than that in R group ; acetoacetate and the level of total ketone body in G group were lower than that in R group at T2 time point; acetoacetic acid and the level of total ketone body at T1 time point were lower than that at T2 time point in R group, and the differ- ences were statistically significant（ P 〈 0.05 ）. KBR in G group and R group was compared at T1 and T2 time point, and the differences were not statistically significant（P 〉0.05 ）. Conclusion： There is no effect on the metabolism of ketone body in the liver by infusion of two crystalloid fluids during perio- perative period, but sodium potassium magnesium calcium glucose injection can reduce the fat decom- position to produce ketone body.

关 键 词：围手术期 晶体液 血糖 乙酰乙酸 Β-羟丁酸 血酮体比率 

分 类 号：R614[医药卫生—麻醉学]