混合糖电解质注射液在腹部中等以上手术病人术后补液中的应用

Effect of carbohydrate-electrolyte solution on the fluid balance and glucose metabolism in patients after major abdomen operations

目的探讨混合糖电解质注射液在腹部中等以上手术病人术后补液中的应用。方法2006年12月至2007年5月中国人民解放军南京军区南京总医院全军普通外科研究所将63例胃肠外科中等以上手术后病人随机分为治疗组(混合糖电解质注射液,31例)和对照组(复方电解质葡萄糖注射液,32例),术后连续输注3d,1500mL/d,其他不足的液体及电解质按病人需要再补充。监测病人术后输液前、输液后0h、2h血糖变化,输液前和连续输液3d后血葡萄糖-6-磷酸脱氢酶、锌、肝肾功能、尿糖和尿酮体的变化,观察生命体征及不良反应情况。结果由于较快恢复进食等原因对照组有3例拒绝输液脱落、治疗组有1例脱落,均未出现相关不良反应和肝肾功能损害。两组病人术后血糖均较术前有所升高,输液后连续3d治疗组血糖增加幅度均低于对照组,术后第1天输液后2h和术后第2天输液时血糖与入院时差值治疗组小于对照组,差异有显著性意义(P=0.009,0.043)。输液后第3天两组病人血葡萄糖-6-磷酸脱氢酶均有所下降,其中治疗组下降幅度低于对照组,差异无显著性意义。治疗组输液后血锌明显增加,与对照组相比差异有显著性意义(P=0.021)。结论腹部中等以上手术后成年病人术后应用混合糖电解质注射液,既可以有效补充血容量和能量,又能补充微量元素锌,同时对血糖水平影响较小。

Objective To evaluate the effect of carbohydrate-electrolyte solution on the fluid balance and glucose metabolism in patients after major abdomen operations. Methods Sixty-three adult patients after major abdominal operations between December 2006 and May 2007 in the Research Institute of General Surgery of Nanjing General Hospital of Nanjing Military Command of PLA were enrolled and randomly divided into two groups： test group （ n = 31 ） and control group （ n = 32）. The test group accepted the fluid therapy of carbohydrate-electrolyte solution, while the control group accepted the fluid of compound electrolyte and glucose solution for 3 days of 1500 mL. The blood glucose before infusion, at Oh and 2h after infusion in three days after operation were assayed. The serum glucose-6-phosphate dehydrogenase, zinc, renal and liver function, urine glucose and ketobodies were measured before infusion and on the fourth day after infusion. The vital signs and other adverse reaction were recorded during infusion periods. Results There was no difference in general characters of patients between two groups. Three patients in the control group and one patient in the test group withdraw from the study. The increase of serum glucose was observed in the two groups after operation, in which the increase in the test group was significantly smaller than the control group. The decrease of glucose-6-phosphate dehydrogenase in the test group was smaller than that of the control group. The blood zinc was significantly elevated after infusion in the test group than in the control group （ P = 0. 021 ）. Conclusion The carbohydrate-electrolyte solution can not only supplement the blood volume in patients after major abdominal operations, but also increase the blood zinc at the condition of smaller elevated blood glucose.