术中碳酸氢钠林格液对单肺通气患者的临床观察

Clinical observation of sodium bicarbonate Ringer's solution on patients with one-lung ventilation

目的探讨术中碳酸氢钠林格液对单肺通气(one-lung ventilation,OLV)患者血气指标、炎性因子及电解质的影响。方法选取2020年7月至2022年12月合肥市第二人民医院胸外科拟择期行胸腔镜手术且术中行OLV的患者40例,随机分为试验组和对照组,每组20例,试验组采用碳酸氢钠林格液,对照组采用乳酸钠林格液。比较两组OLV前后不同时刻血气指标、电解质指标、炎性因子指标和不良反应发生率。结果40例患者中男24例,女16例,年龄18~65岁,平均(48.5±12.1)岁。OLV期间试验组SpO_(2)<90%的次数及时间均低于对照组。与入室时(T0)相比,气管插管后双肺通气时(T1)、OLV 30 min(T2)、手术结束前双肺通气时(T3)两组PaO_(2)和SaO_(2)均升高,且T2试验组SaO_(2)高于对照组;T1、T2和T3两组pH和BE均下降,其中T2和T3试验组pH和BE均高于对照组,差异均有统计学意义(P<0.05)。与T0相比,T1、T2和T3两组K^(+)均下降、Cl^(-)均升高;T1、T2和T3试验组Mg^(2+)低于对照组,差异均有统计学意义(P<0.05)。术毕和术后6 h试验组TNF-a、IL-6低于对照组,差异均有统计学意义(P<0.05)。结论碳酸氢钠林格液可改善OLV患者术中呼吸系统的稳定性,维持电解质平衡,减少炎症应激反应。

Objective To explore the effects of intraoperative sodium bicarbonate Ringer's solution on blood gas indicators,inflammatory factors,and electrolytes in patients with one-lung ventilation(OLV).Methods A total of 40 patients who were scheduled to undergo thoracoscopic surgery and underwent OLV during the surgery in the Department of Thoracic Surgery of Hefei Second People's Hospital from July 2020 to December 2022 were seleced,and were randomly divided into experimental group and control group,with 20 patients in each group.The experimental group received sodium bicarbonate Ringer's solution,while the control group received sodium lactate Ringer's solution.The blood gas indicators,electrolyte indicators,inflammatory factor indicators,and incidence of adverse reactions before and after OLV were compared between the two groups.Results Among the 40 patients,there were 24 males and 16 females,aged 18 to 65 years,with an average age of(48.5±12.1)years.The frequency and duration of SpO_(2) below 90%during OLV in the experimental group were lower than those in the control group.Compared with the time of entering the room(T0),PaO_(2) and SaO_(2) of the two groups at the time of bilateral ventilation after tracheal intubation(T1),OLV for 30 min(T2)and bilateral ventilation before operation(T3)all increased,and SaO_(2) of the experimental group at the time of T2 was higher than that of control group,and the difference was statistically significant(P<0.05).Compared with the time of T0,the pH and BE of the two groups all decreased at the time of T1,T2 and T3,and the pH and BE of experimental groups at the time of T2 and T3 were higher than those of the control group,the differences were statistically significant(all P<0.05).Compared with the time of T0,the K^(+)and Cl^(-)of the two groups were respectively decreased and increased at the time of T1,T2 and T3,and the Mg^(2+)of experimental groups at the time of T1,T2 and T3 were lower than those of the control group,the differences were statistically significant(all P<0.05).TNF-a and IL-6 in the experimental group at the end of operationm at six hours after operation were lower than those in the control group,respectively,and the differences were statistically significant(P<0.05).Conclusions Sodium bicarbonate Ringer's solution can improve the stability of the respiratory system,maintain electrolyte balance and reduce inflammatory stress reaction in OLV patients during surgery.