碳酸氢钠林格液和复方林格液在控制性低中心静脉压肝切除术中的应用效果比较  

Comparison of the effect of sodium bicarbonate Ringer′s solution and compound Ringer′s solution in controlled low central venous pressure hepatectomy

作　　者：米琰 白玉 徐刚 李素芬 卢锡华 MI Yan;BAI Yu;XU Gang;LI Sufen;LU Xihua(Department of Anesthesia and Perioperative Medicine,the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州大学附属肿瘤医院麻醉与围手术期医学科,河南郑州450000

出　　处：《新乡医学院学报》2024年第5期438-442,共5页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20190668)。

摘　　要：目的探讨碳酸氢钠林格液和复方林格液对控制性低中心静脉压(CLCVP)肝切除术患者的酸碱平衡及肝肾功能的影响。方法选择2020年6月至2022年6月在郑州大学附属肿瘤医院行CLCVP肝切除术的60例原发性肝癌患者为研究对象,按随机数字表法将患者分为碳酸氢钠林格液组和复方林格液组,每组30例。在麻醉诱导后至肝实质离断前,碳酸氢钠林格液组患者输注碳酸氢钠林格液,复方林格液组患者输注复方林格液。分别于麻醉诱导前(T_(1))、手术开始时(T_(2))、术中2 h(T_(3))、术中4 h(T_(4))和手术结束时(T_(5)),使用血气分析仪检测2组患者的pH值、碱剩余(BE)、血乳酸(Lac)水平;分别于术前24 h和术后24 h使用全自动生化分析仪检测2组患者血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血尿素氮(BUN)及血肌酐(Scr)水平;比较2组患者体质量、手术时间、术中输液量、尿量、手术过程中酸碱平衡变化及手术前后肝肾功能变化。结果2组患者体质量、手术时间、术中输液量及尿量比较差异均无统计学意义(P>0.05)。T_(1)时,2组患者pH值、BE、Lac水平比较差异无统计学意义(P>0.05);与T_(1)时比较,复方林格液组患者T_(2)时pH值升高,T_(3)~T_(5)时均降低,T_(2)~T_(5)的BE及Lac水平均升高(P<0.05);与T_(1)时比较,碳酸氢钠林格液组患者T_(2)时pH值显著升高,T_(3)时显著下降,T_(2)、T_(3)时BE及Lac水平均显著升高(P<0.05),T_(4)、T_(5)时pH值、BE、Lac水平与T_(1)时比较差异均无统计学意义(P>0.05);T_(5)时碳酸氢钠林格液组患者pH值显著高于复方林格液组,BE及Lac水平显著低于复方林格液组(P<0.05)。术前24 h,2组患者ALT、AST、BUN及Scr水平比较差异无统计学意义(P>0.05);2组患者术后24 h与术前24 h时的ALT、AST、BUN及Scr水平比较差异无统计学意义(P>0.05);术后24 h,2组患者的ALT、AST、BUN及Scr水平比较差异无统计学意义(P>0.05)。结论在CLCVP肝切除Objective To investigate the influence of sodium bicarbonate Ringer′s solution and compound Ringer′s solution on patients′acid-base balance and liver and kidney function during controlled low central venous pressure(CLCVP)hepatectomy.Methods A total of 60 patients with primary liver cancer who underwent CLCVP hepatectomy in the Affiliated Cancer Hospital of Zhengzhou University from June 2020 to June 2022 were selected and randomly divided into the sodium bicarbonate Ringer′s solution group and compound Ringer′s solution group,with 30 patients in each group.Patients in the sodium bicarbonate Ringer′s solution group were infused with sodium bicarbonate Ringer′s solution,while patients in the compound Ringer′s solution group were infused with compound Ringer′s solution after anesthesia induction and before liver parenchymal disconnection.The pH value,base excess(BE)and blood lactic acid(Lac)levels were detected using the blood gas analyzer in the two groups before anesthesia induction(T_(1)),at the beginning of surgery(T_(2)),2 h during surgery(T_(3)),4 h during surgery(T_(4)),and at the end of surgery(T_(5)),respectively.The levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood urea nitrogen(BUN),and serum creatinine(Scr)were detected using the automatic biochemical analyzer 24 h before and 24 h after surgery,respectively.The body mass,surgical time,intraoperative infusion volume,urine volume,changes in body acid-base balance during surgery,and changes in liver and kidney function before and after surgery between the two groups were compared.Results There was no statistically significant difference in body mass,surgical time,intraoperative infusion volume,and urine volume between the two groups of patients(P>0.05).At T_(1),there was no statistically significant difference in pH value,BE and Lac levels between the two groups of patients(P>0.05).Compared to T_(1),the pH value in the compound Ringer′s solution group increased at T_(2)and decreased at T_(3),T_(4)and T_

关 键 词：控制性低中心静脉压肝切除术 原发性肝癌 碳酸氢钠林格液 复方林格液 酸碱平衡 肝肾功能 

分 类 号：R657.3[医药卫生—外科学]