碳酸氢钠林格氏液对腹腔镜右半肝切除患者术中乳酸浓度和术后早期恢复质量的影响  

Impact of bicarbonate ringer's solution on perioperative lactic acid concentration and early recovery quality in patients undergoing laparoscopic right hemihepatectomy

作　　者：刘莹莹 张慕春 窦梓菁 陈齐[1] 胡宪文[1] 周玉梅 LIU Ying-ying;ZHANG Mu-chun;DOU Zi-jing;CHEN Qi;HU Xian-wen;ZHOU Yu-mei(Department of Anesthesiology,Second Affiliated Hospital of Anhui Medical University,Hefei 230601,Anhui,China)

机构地区：[1]安徽医科大学第二附属医院麻醉与围手术期医学科,合肥230601

出　　处：《医学研究生学报》2022年第7期741-746,共6页Journal of Medical Postgraduates

基　　金：医路“格”新-液体治疗科研基金。

摘　　要：目的当前临床所选用乳酸钠林格氏液(LR)存在增加血浆乳酸含量,加重患者内环境的紊乱,影响患者的苏醒与预后等缺陷。文中观察碳酸氢钠林格氏液(BRS)对腹腔镜右半肝切除术患者术中乳酸浓度和术后早期恢复质量的影响。方法回顾性分析2020年10月—2021年4月期间60例于安徽医科大学第二附属医院择期行全身麻醉下腹腔镜右半肝切除术患者临床资料,并采用随机数字表法分为乳酸钠林格氏液组(LR组)和碳酸氢钠林格氏液组(BRS组)。2组患者均采用3~5 mL/(kg·h)为基础输液速度分别使用乳酸钠林格氏液和碳酸氢钠林格氏液。记录术前、术后1 d、3 d早期15项恢复质量量表(QoR-15)评分;记录入室后(T_(1))、手术开始时(T_(2))、肝切除前5 min(T_(3))、肝切除后5 min(T_(4))、手术结束时(T_(5))时患者pH、BE、HCO_(3)^(-)、PCO_(2)、K^(+)值和MAP、HR、CI值以及T_(1-5)、术后2 h(T_(6))、术后1 d(T_(7))、术后2 d(T_(8))Lac值。记录2组患者术中去氧肾上腺素的使用量以及术后睁眼时间、应答时间、拔管时间、术后患者的在AICU停留时间、术后首次通气时间、术后首次下地时间、术后并发症。结果与术前相比,2组患者术后1 d、3 d早期15项恢复质量评分降低(P<0.05)。与T_(1)时比较,T_(3-5)时LR组pH、BE、HCO_(3)^(-)降低,K^(+)、PCO_(2)升高,T_(3-7)时Lac升高(P<0.05);T_(4)、T_(5)时BRS组pH、BE、HCO_(3)^(-)降低,T_(3-5)时PCO_(2)升高(P<0.05),T_(4)、T_(5)时K^(+)升高,T_(4-7)时Lac升高(P<0.05);与LR组比较,T_(3-5)时BRS组pH、BE、HCO_(3)^(-)、PCO_(2)升高,K^(+)降低,T_(4-6)时Lac降低,睁眼时间、应答时间、拔管时间、术后患者AICU停留时间、术后首次通气时间、术后首次下地时间缩短,术后并发症减少,术后1d、3d早期15项恢复质量评分升高(P<0.05)。结论碳酸氢钠林格氏液能减少腹腔镜右半肝切除术的代谢酸中毒的发生,减慢术中和术后早期乳酸升高速度,提�Objective The current use of lactated ringer's solution in clinic exists some defects such as increasing the content of plasma lactic acid,aggravating the disorder of internal environment,and affecting the recovery and prognosis of patients.This study aimed to observe the impact of bicarbonate ringer's solution(BRS)on acid-base balance and early recovery quality in patients undergoing laparoscopic right hemihepatectomy.Methods The clinical data of sixty patients undergoing laparoscopic right hemihepatectomy during October 2020 and April 2021 in our hospital was collected.Patients were divided into two groups by random number table method:lactate ringer's solution(group LR)and bicarbonated ringer's solution(group BRS),and were used at the infusion rate of 3~5 mL/(kg·h)LR and BRS respectively.The early recovery quality before operation and 1 d,3 d after operation was measured by use of the QoR-15.pH,BE,HCO_(3)^(-),PCO_(2),K^(+)value and MAP,HR,CI value were recorded after admission(T_(1)),at the beginning of surgery(T_(2)),5 min before liver resection(T_(3)),5 min after liver resection(T_(4)),and at the end of the surgery(T_(5)).Lac values were recorded during T_(1-5),2 h after surgery(T_(6)),1 d after surgery(T_(7)),and 2 d after surgery(T_(8)).The amount of phenylephrine used in the two groups,the postoperative eye opening time,response time,extubation time,postoperative stay time in AICU,first postoperative ventilation time,first postoperative ground time and postoperative complications in both groups were recorded.Results In contrast to preoperation,the early 15-item quality of recovery scale score of 1 d and 3 d after operation decreased in both groups(P<0.05).Compared with T_(1),PH,BE and HCO_(3) in group LR dropped,but K^(+)and PCO_(2) raised at T_(3-5),and Lac rose at T_(3-7)(P<0.05);At T_(4) and T_(5),PH,BE and HCO_(3) in group BRS declined,while PCO_(2) increased at T_(3-5)(P<0.05),K^(+)increased at T_(4) and T_(5),and Lac climbed at T_(4-7)(P<0.05).PH,When compared to group LR,pH,BE,HCO_(3) and PCO_(2)

关 键 词：碳酸氢钠林格氏液 腹腔镜右半肝切除术 乳酸 早期恢复质量 

分 类 号：R657.3[医药卫生—外科学]