醋酸钠林格液对围手术期胆道闭锁患儿酸碱平衡和电解质的影响  

Effects of acetated Ringer s solution on acid-base balance and electrolytes in biliary atresia children

作　　者：刘祥[1] 曹红彦 乔丽[1] 张琦[1] 石磊[1] Liu Xiang;Cao Hongyan;Qiao Li;Zhang Qi;Shi Lei(Department of Operation Room and Anesthesiology,Children's Hospital of Hebei Province,Shijiazhuang 050030,China)

机构地区：[1]河北医科大学附属河北省儿童医院手术麻醉科,河北省石家庄市050030

出　　处：《临床小儿外科杂志》2020年第6期503-507,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的评价醋酸钠林格注射液对围手术期胆道闭锁(Biliary Atresia,BA)患儿血乳酸和电解质的影响。方法选择2017年1月至2018年12月河北医科大学附属河北省儿童医院在全身麻醉下行Kasai术的60例BA患儿作为研究对象,手术日龄21~65 d,ASA分级Ⅱ或Ⅲ级,随机分为乳酸钠林格注射液组(n=30)和醋酸钠林格注射液组(n=30)。根据Holliday和Segar公式输液原则进行围术期液体治疗。分别于切皮前(T 1)、手术结束时(T 2)和术后12 h时(T 3)3个时间点检测并记录静脉血Na^+、K^+、HCO3^-、Cl^-、Ca^2+、血糖、乳酸浓度和pH值。术中监测体温,并记录术中血管活性药物应用和低血糖发生情况。术后统计失血量、输液量和尿量。结果两组患儿失血量、输液量和尿量差异无统计学意义(P>0.05),术中血管活性药物应用和低血糖发生情况比较差异无统计学意义(P>0.05)。与乳酸钠林格注射液组比较,T 2时点醋酸林格注射液组乳酸浓度降低(P<0.05);与T 3时点比较,醋酸钠林格注射液组和乳酸钠林格注射液组T 1、T 2时点体温降低(P<0.05)。结论醋酸钠林格液可以用于Kasai手术患儿术中液体治疗,可维持机体电解质和酸碱内环境的稳定。Objective To evaluate the efficacy of sodium acetate ringer on fluid therapy in biliary atresia(BA)children.Methods A total of 60 children aged 21 to 65 days,American Society of Anesthesiologists physical statusⅡ/Ⅲ,scheduled for elective Kasai surgery under general anesthesia were randomized divided into LR:sodium lactate ringer s injection group and AR:sodium acetate ringer s injection group(n=30 each).The concentrations of sodium ion,potassium ion,bicarbonate ion,chorine ion,calcium ion and lactate and pH values were recorded at the timepoints of pre-skin incision(T 1),end of surgery(T 2)and postoperative 12 h(T 3).Intraoperative body temperature was monitored,and intraoperative vasoactive agents and hypoglycemia were recorded.Postoperative blood loss,transfusion volume and urine volume were counted.Results No significant inter-group statistical difference existed in volume of blood loss,transfusion volume,volume of urine,intraoperative use of vasoactive agents or occurrence of hypoglycema(P>0.05).As compared with LR:sodium lactate ringer s injection group,lactae concentration was significantly lower in group AR:sodium acetate ringer s injection group at T 2(P<0.05);as compared with T 3,the temperatures of both groups decreased at T 1 and T 2(P<0.05).Conclusion Acetated Ringer may be a feasible and effective alternative for maintaining the in vivo balances of electrolytes and acid-base during pediatric Kasai surgery.

关 键 词：胆道闭锁 水电解质平衡 酸碱平衡 手术期间 

分 类 号：R977.7[医药卫生—药品] R722[医药卫生—药学]