碳酸氢钠林格液在脊柱椎体肿瘤切除术中液体治疗的疗效观察  

Efficacy of sodium bicarbonate Ringer s solution in fluid therapy in spinal vertebral tumor resection

作　　者：祁富军 廖博 赵建奎 QI Fujun;LIAO Bo;ZHAO Jiankui(Department of Orthopedic Anesthesia,Air Force Medical University,Xi'an 710038,China;Department of Orthopedics,Air Force Medical University,Xi'an 710038,China;Department of Anesthesia,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院骨科麻醉室,陕西西安710038 [2]空军军医大学唐都医院骨科,陕西西安710038 [3]空军军医大学唐都医院麻醉科,陕西西安710038

出　　处：《空军军医大学学报》2023年第11期1097-1102,共6页Journal of Air Force Medical University

基　　金：国家自然科学基金(82174166)。

摘　　要：目的观察碳酸氢钠林格液对脊柱椎体肿瘤患者术中机体酸碱平衡及电解质的影响,评价其临床应用的有效性和安全性。方法采用前瞻性随机对照研究的方法,纳入104例因椎体肿瘤行椎体全切手术的患者进行研究。采用随机数字表法将患者分为乳酸钠林格液组(LR组)和碳酸氢钠林格液组(CR组),每组52例,LR组和CR组分别给予乳酸钠林格液和碳酸氢钠林格液进行液体治疗,不交叉输入其他晶体液。分别于麻醉诱导时(T1)、椎体肿瘤切除后(T2)、手术结束后(T3)三个时间点记录患者的生命体征以及抽取动脉血进行血气分析;记录术中患者的出血量、输血量以及麻黄碱的使用量;记录并比较两组患者pH值、乳酸、电解质及晶体液用量的差异。结果两组患者T1时刻动脉血Na+、K+、Ca 2+、血细胞比容(HCT)、血红蛋白(Hb)、HCO 3-等实验室指标以及心率、平均动脉压、血氧饱和度、体温等生命体征比较差异均无统计学意义(P>0.05);LR组中,与T1时刻相比较,T2、T3时刻乳酸浓度升高(P<0.05),Hb、HCT浓度均显著降低(P<0.05);T2、T3时刻CR组血乳酸水平显著低于LR组(P<0.05),pH值、碱剩余值、HCO 3-均显著高于LR组(P<0.05)。结论在脊柱椎体肿瘤手术中,输注碳酸氢钠林格液能够明显降低患者动脉血的乳酸水平,并有助于促进机体酸碱平衡,维护内环境血流动力学平衡。Objective To observe the effects of sodium bicarbonate Ringer s solution on acid-base balance and electrolytes in patients undergoing spinal vertebral tumor resection,and to evaluate its efficacy and safety in clinical application.Methods A prospective randomized controlled study was conducted in 104 patients undergoing total vertebrectomy for vertebral tumors.Random number table method was used to divide the patients into lactated Ringer s solution group(LR group)and sodium bicarbonate Ringer s solution group(CR group),with 52 patients in each group.LR group was treated with lactated Ringer s solution for liquid therapy,while CR group was treated with sodium bicarbonate Ringer s solution for liquid therapy,without cross feeding other crystalloid solutions.We recorded the patients vital signs and collected arterial blood for blood gas analysis at three time points immediately after anesthesia induction(T1),after vertebral tumor resection(T2),and after the operation(T3).Intraoperative blood loss,blood transfusion and ephedrine dosage were recorded.The differences in pH value,lactic acid,electrolytes and dosage of crystalloid solutions between the two groups were recorded and compared.Results There were no significant differences in laboratory indexes such as Na+,K+,Ca 2+,hematocrit(HCT),hemoglobin(Hb),HCO 3-in arterial blood and vital signs such as heart rate,mean arterial pressure,blood oxygen saturation and body temperature(P>0.05)between the two groups at T1.Compared with T1,the concentration of lactic acid increased and the concentrations of Hb and HCT were significantly decreased at T2 and T3(P<0.05).The blood lactate level in CR group at T2 and T3 was significantly lower than that in LR group(P<0.05),while pH value,base excess value,and HCO 3-in CR group were significantly higher than those in LR group(P<0.05).Conclusion In spinal vertebral tumor surgery,infusion of sodium bicarbonate Ringer s solution can significantly reduce blood lactate level in the arterial blood of patients,and help to promote the body

关 键 词：乳酸钠林格液 碳酸氢钠林格液 脊柱肿瘤手术 围术期 

分 类 号：R738.1[医药卫生—肿瘤]