术中晶体输液和限制晶体输液方案比较研究

Clinical Comparative Study on the Intraoperative Transfusion Regimen of Crystalloid Solution and Limited Crystalloid Solution

目的:在于比较术中晶体输液方案和限制晶体输液方案,以期能对术中合理输液有一定帮助.方法:非体外循环择期手术成年患者20例,分晶体输液组(A组,n=10)及限制晶体输液组(B组,n=10).两组均在入室后至切皮前静脉输入5%葡萄糖1 ml/(kg·h)(时间从术前午夜0:00至切皮),补充术前损失体液.手术开始后,A组按8～14 ml/(kg·h)输入乳酸钠林格氏液(LR);B组切皮后按LR:5%葡萄糖=1:1的比例第1小时以10～12 ml/(kg·h)输给,以后为5～6 ml/(kg·h),并配合适量的706代血浆.两组在出血超过全血容量的15%时输入等量全血.结果:(1)血容量、中心静脉压、平均桡动脉压:A组切皮后3 h及术毕升高较麻醉前有显著差异(P<0.05),B组能维持在正常范围内;(2)术中每个患者尿量均数:A组(4.15±1.51) ml/(kg·h),B组(1.65±1.12)ml/(kg·h);(3)A组尿钠排出量明显增多;(4)B组血钠值切皮后3 h及术毕低于正常值;(5)B组pH值较A组低,BE负值较A组大.结论:两组输液方案在术中均能维持好血容量、桡动脉压、中心静脉压、尿量等,但晶体输液组有钠水负荷过量倾向,应注意由此引起的组织水肿;限制晶体输液方案在维持血钠、改善代谢性酸中毒方面不如晶体输液组.

Objective：To compare the intraoperative transfusion regimen of crystalloid solution with limited crystalloid solution to determine the rational transfusion regimen. Methods：20 adult patients undergoing non-extracorporeal circulation operations and having no disorders of heart ,lung,kidney,electrolyte disturbance ,anemia and abnormal blood volume were collected ;the operations lasted more than three hours. They were divided into erystalloid group （Group A, n= 10） and limited erystalloid group （Group B,n= 10）. 5% GS 1 ml/（kg · h）（the time was calculated from midnight to the beginning of the operations） were administered to the two groups of patient to supplement the lost body fluid before the operations. When the operations began, Lactated Ringer＇s solution （LR） was administered to the patients of group A at the rate of 8-14 ml/kg/h, while the equal amount of LR and 5% GS （1 ： 1）, and an amount of 706 plasma were given to the group B at the rate of 10-12 ml/（kg · h） within the first hour and then at the rate of 4-6 ml/（kg · h）. Whole blood was transfused to both groups of patients when they lost more than 15% of their blood volume. Results： （1）blood volume, central venous pressure and mean arterial pressure of group A three hours after the operations and at the end of the operations were significantly higher than those before operations （P〈0.05）, while those of Group B were kept within the normal ranges; （2） mean urine volume： Group A： （41.5±1.51） ml/（kg · h） ,Group B（1.65±1.12）ml/ （kg · h）; （3）Natruresis of Group A was markedly increased; （4）Sera sodium of Group B three hour after beginning of the operations and at the end of the operations were lower than normal value; （5）pH of Group B was lower than that of Group A,while BE negative value of Group B was higher than that of Group A. Conclusion：Two transfusion regimens could maintain blood volume, mean arterial pressure,central venous pressure, urine volume ete, but the erystalloid group had the tendency of overcharge of sodium and water. So we should take notice of tissue edema resulting from it. The limited erystalloid transfusion regimen is not as good as erystalloid group in maintaining serum sodium and improv- ing acidosis.