7.5%高渗盐水对腹部外科手术后液体平衡的影响  

Effects of 7.5 % hypertonic saline on fluid balance after abdominal surgery

作　　者：邵永胜[1] 彭开勤[1] 张应天[1] 全卓勇[1] 龚少敏[1] 

机构地区：[1]江汉大学附属医院普通外科,武汉430015

出　　处：《中华实验外科杂志》2004年第2期220-221,共2页Chinese Journal of Experimental Surgery

摘　　要：目的　探讨 7.5 %高渗盐水对腹部外科手术后液体平衡的影响。方法　 2 0例择期腹部大手术和 6例重症腹膜炎急诊手术患者 ,配对分为两组对比。术毕进入外科ICU后 ,研究组(n =13 )应用 7.5 %高渗盐水 (4ml/kg体重 ) ,后续平衡液 ;对照组 (n =13 )仅用平衡液。比较两组患者的输液量、尿量、液体平衡和体重变化。结果　与对照组相比 ,研究组术后尿量较多 ,术后第 1天和术后 48h的差异有显著性 (t =2 .6612 ,P =0 .0 2 0 7;t=3 .6863 ,P =0 .0 0 3 1) ;手术当日和术后 48h的液体正平衡量较少 ,差异有显著性 (t =2 .3 40 8,P =0 .0 2 79;t =2 .3 691,P =0 .0 2 62 ) ;术后体重增加幅度低于对照组 ,差异有显著性 (t =2 .2 761,P =0 .0 42 0 ) ;术后体重下降时间早于对照组 ,差异有非常显著性 (t =7.615 4,P =0 .0 0 44 )。结论　 7.5 %高渗盐水有明显的利尿作用 ,可动员、排出体内扣押的过多液体 ,减少腹部外科手术后液体正平衡 ,促进液体负平衡提前出现。Objective To investigate the effects of 7.5 % hypertonic saline (HS) on fluid balance after abdominal surgery.Methods Twenty patients undergoing elective major abdominal surgery and 6 patients with severe secondary peritonitis who underwent emergent laparotomy were studied.The patients were assigned to receive either Ringer lactate solution following 4 ml/kg of 7.5 % HS (experimental group,n=13) or Ringer lactate solution (control group,n=13) during the early postoperative period in the surgical intensive care unit.Fluid infusion volumes,urine outputs,fluid balance and body weight change were compared between the two groups.Results Urine outputs on the first postoperative day and during the first 48 h following surgery in experimental group were significantly more than in control group (t=2.661?2,P=0.020?7;t=3.686?3,P=0.003?1,respectively).The volumes of positive fluid balance on the operative day and during the first 48 h following surgery were significantly lower among patients treated with HS than those in control group (t=2.340?8,P=0.027?9;t=2.369?1,P=0.026?2,respectively).Body weight gain after surgery was significantly lesser in experimental group than in control group (t=2.276?1,P=0.042?0).The time of body weight fall from the end of surgery was significantly shorter in experimental group than in control group (t=7.615?4,P=0.004?4).Conclusion 7.5% HS had an intense diuretic effect,caused mobilisation of the retained fluid excess,which could reduce positive fluid balance and accelerate negative fluid balance appearance more early after abdominal surgery.

关 键 词：高渗盐水 腹部 外科手术 液体平衡 

分 类 号：R656[医药卫生—外科学]