醋酸钠林格注射液应用于小儿骨科手术补液对血糖及乳酸的影响
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摘要
目的:评价醋酸钠林格注射液在小儿骨科手术补液中的应用价值。方法:选取2017年7月至2018年11月在我院择期行胫骨假关节切除手术的患儿60例(年龄1～6岁,体质量8～20 kg,ASAⅠ～Ⅱ级),按随机数表法分为观察组和对照组各30例。观察组患儿术中输注醋酸钠林格注射液补液,对照组患儿输注乳酸钠林格注射液,术中液体维持量按4∶2∶1法则计算。分别于麻醉诱导后(T0)、手术1 h(T1)、手术2 h(T2)、手术结束时(T3)监测动脉血气、电解质、血乳酸、血糖、血流动力学指标、总输液量、出血量、尿量。结果:两组患儿手术时间、术中出血量、总输液量比较差异均无统计学意义(P均>0.05)。观察组患儿在T2、T3的血乳酸水平低于对照组,在T3的血糖水平低于对照组(P均<0.05)。结论:在小儿骨科手术中,应用醋酸钠林格注射液补液对血糖、乳酸的影响较小,比乳酸钠林格注射液更安全有效。
Objective: To evaluate the application value of sodium acetate ringer injection on blood glucose and lactic acid in pediatric orthopaedic surgery. Methods: Totally 60 patients(age from 1 to 6 years old,body mass from 8 to 20 kg,ASA from Ⅰ to Ⅱ) undergoing pediatric orthopaedic surgery in our hospital from Jul. 2017 to Nov. 2018 were extracted to be divided into the observation group and the control group via the random number table,with 30 cases in each group. The observation group was intraoperatively infused with sodium acetate linger injection,and the control group was infused with sodium lactate linger injection. The fluid maintenance was calculated according to the 4 ∶ 2 ∶ 1 rule. Arterial blood gas,electrolyte,blood lactic acid,blood glucose,hemodynamic indexes,total infusion volume,blood loss and urine volume were monitored after anesthesia induction(T0),1 h after surgery(T1),2 h after surgery(T2),and at the end of surgery(T3). Results: There was no statistically significant difference in surgical time,intraoperative blood loss and total infusion volume between two groups(P>0.05). In the observation group,the blood lactic acid level in T2 and T3 was lower than that in the control group,and the blood glucose level in T3 was lower than that in the control group(P<0.05).Conclusion: In pediatric orthopedic surgery,sodium acetate ringer injection has few effects on blood glucose and lactic acid,which is safer and more effective than sodium lactate ringer injection.
Objective: To evaluate the application value of sodium acetate ringer injection on blood glucose and lactic acid in pediatric orthopaedic surgery. Methods: Totally 60 patients(age from 1 to 6 years old,body mass from 8 to 20 kg,ASA from Ⅰ to Ⅱ) undergoing pediatric orthopaedic surgery in our hospital from Jul. 2017 to Nov. 2018 were extracted to be divided into the observation group and the control group via the random number table,with 30 cases in each group. The observation group was intraoperatively infused with sodium acetate linger injection,and the control group was infused with sodium lactate linger injection. The fluid maintenance was calculated according to the 4 ∶ 2 ∶ 1 rule. Arterial blood gas,electrolyte,blood lactic acid,blood glucose,hemodynamic indexes,total infusion volume,blood loss and urine volume were monitored after anesthesia induction(T0),1 h after surgery(T1),2 h after surgery(T2),and at the end of surgery(T3). Results: There was no statistically significant difference in surgical time,intraoperative blood loss and total infusion volume between two groups(P>0.05). In the observation group,the blood lactic acid level in T2 and T3 was lower than that in the control group,and the blood glucose level in T3 was lower than that in the control group(P<0.05).Conclusion: In pediatric orthopedic surgery,sodium acetate ringer injection has few effects on blood glucose and lactic acid,which is safer and more effective than sodium lactate ringer injection.
引文
[1]MA P,WANG B,ZHANG J,et al.Balanced crystalloids for intravenous fluid therapy in critically ill and non-critically ill patients:A protocol for systematic review and network metaanalysis[J].Medicine(Baltimore),2018,97(51):e13683.
[2]DISMA N,MAMELI L,PISTORIO A,et al.A novel balanced isotonic sodium solution vs normal saline during major surgery in children up to 36 months:A multicenter RCT[J].Paediatric anaesthesia,2014,24(9):980-986.
[3]FELLOWS K K.Balanced versus unbalanced crystalloids in initial sepsis fluid resuscitation[J].J Emerg Nurs,2018,44(2):184-185.
[4]刘艳秋,任益民,曾丽,等.醋酸钠林格液和乳酸钠林格液对血乳酸、血糖及电解质的影响[J].贵阳医学院学报,2016,41(2):222-224.
[5]吴洁,王天龙,张瑛,等.不同晶体液对神经外科肿瘤切除术患者血清晶体渗透压、电解质、乳酸及血糖的影响[J].中国现代医学杂志,2014,24(3):92-96.
[6]JOSEPH B,MATHEW G.Management of congenital pseudarthrosis of the tibia by excision of the pseudarth-rosis,onlay grafting,and intramedullary nailing[J].Journal of pediatric orthopedics,2000,9(1):16-23.
[7]高田田,孙超,冷冰,等.钠钾镁钙葡萄糖注射液临床使用合理性及安全性分析[J].中国药物应用与监测,2017,14(4):240-242.
[8]MAGDER S,POTTER B J,VARENNES B D,et al.Fluids after cardiac surgery:A pilot study of the use of colloids versus crystalloids[J].Critical care medicine,2010,38(11):2177-2124.
[9]邓小明,郭曲练,郭向阳,等.醋酸钠林格液临床应用专家共识[J].国际麻醉学与复苏杂志,2016,39(1):1-5.
[10]洪彬源,刘洪珍,李云,等.不同晶体液容量治疗对烫伤大鼠早期心肌功能的影响[J].上海医学,2016,39(12):743-750.
[11]JANSEN T C,VAN BOMMEL J,BAKKER J.Blood lactate monitoring in critically ill patients:A systematic health technology assessment[J].Critical Care Medicine,2009,37(10):2827-2839.
[12]江荣林,雷澍,王灵聪.乳酸代谢和乳酸清除率对危重病患者预后评估的价值[J].浙江临床医学,2009,11(1):92-94.
[13]高卉.围术期血糖管理专家共识(快捷版)[J].临床麻醉学杂志,2016,32(1):93-95.
[14]YAMASAKI K,INAGAKI Y,MOCHIDA S,et al.Effect of intraoperative acetated Ringer’s solution with 1%glucose on glucose and protein metabolism[J].Journal of anesthesia,2010,24(3):426-431.
[15]GROENEVELD A B,NAVICKIS R J,WILKES M M.Update on the comparative safety of colloids:A systematic review of clinical studies[J].Annals of surgery,2011,253(3):470-483.
[16]杜真,屈双权,危思维,等.醋酸钠林格注射液应用于新生儿腹腔镜手术中补液对血糖及电解质酸碱平衡的影响[J].儿科药学杂志,2019,25(1):15-17.
[2]DISMA N,MAMELI L,PISTORIO A,et al.A novel balanced isotonic sodium solution vs normal saline during major surgery in children up to 36 months:A multicenter RCT[J].Paediatric anaesthesia,2014,24(9):980-986.
[3]FELLOWS K K.Balanced versus unbalanced crystalloids in initial sepsis fluid resuscitation[J].J Emerg Nurs,2018,44(2):184-185.
[4]刘艳秋,任益民,曾丽,等.醋酸钠林格液和乳酸钠林格液对血乳酸、血糖及电解质的影响[J].贵阳医学院学报,2016,41(2):222-224.
[5]吴洁,王天龙,张瑛,等.不同晶体液对神经外科肿瘤切除术患者血清晶体渗透压、电解质、乳酸及血糖的影响[J].中国现代医学杂志,2014,24(3):92-96.
[6]JOSEPH B,MATHEW G.Management of congenital pseudarthrosis of the tibia by excision of the pseudarth-rosis,onlay grafting,and intramedullary nailing[J].Journal of pediatric orthopedics,2000,9(1):16-23.
[7]高田田,孙超,冷冰,等.钠钾镁钙葡萄糖注射液临床使用合理性及安全性分析[J].中国药物应用与监测,2017,14(4):240-242.
[8]MAGDER S,POTTER B J,VARENNES B D,et al.Fluids after cardiac surgery:A pilot study of the use of colloids versus crystalloids[J].Critical care medicine,2010,38(11):2177-2124.
[9]邓小明,郭曲练,郭向阳,等.醋酸钠林格液临床应用专家共识[J].国际麻醉学与复苏杂志,2016,39(1):1-5.
[10]洪彬源,刘洪珍,李云,等.不同晶体液容量治疗对烫伤大鼠早期心肌功能的影响[J].上海医学,2016,39(12):743-750.
[11]JANSEN T C,VAN BOMMEL J,BAKKER J.Blood lactate monitoring in critically ill patients:A systematic health technology assessment[J].Critical Care Medicine,2009,37(10):2827-2839.
[12]江荣林,雷澍,王灵聪.乳酸代谢和乳酸清除率对危重病患者预后评估的价值[J].浙江临床医学,2009,11(1):92-94.
[13]高卉.围术期血糖管理专家共识(快捷版)[J].临床麻醉学杂志,2016,32(1):93-95.
[14]YAMASAKI K,INAGAKI Y,MOCHIDA S,et al.Effect of intraoperative acetated Ringer’s solution with 1%glucose on glucose and protein metabolism[J].Journal of anesthesia,2010,24(3):426-431.
[15]GROENEVELD A B,NAVICKIS R J,WILKES M M.Update on the comparative safety of colloids:A systematic review of clinical studies[J].Annals of surgery,2011,253(3):470-483.
[16]杜真,屈双权,危思维,等.醋酸钠林格注射液应用于新生儿腹腔镜手术中补液对血糖及电解质酸碱平衡的影响[J].儿科药学杂志,2019,25(1):15-17.