7．5％高渗盐水对急性弥漫性腹膜炎术后液体平衡的影响

Effects of 7.5 % hypertouic saline on fluid balance after emergency laparotomy for acute diffuse peritonitis

目的观察7．5％高渗盐水对急性弥漫性腹膜炎急诊手术后液体平衡的影响。方法42例急性弥漫性腹膜炎急诊手术患者，术毕进入外科ICU后，实验组（n=21）输注7．5％高渗盐水（4ml／kg体重）后续平衡液；对照组（n=21）仅输平衡液。比较两组患者的输液量、尿量、液体平衡、体重变化以及并发症发生率和病死率。结果与对照组比较，实验组手术日的输液量减少（P〈0．05）；手术日和术后第1天的尿量较多（P〈0．05，P〈0．05），液体正平衡量减少（P〈0．01，P〈0．01）；术后体重增加幅度降低（P〈0．01），体重下降时间提前（P〈0．01）；总体并发症发生率较低（P〈0．05）。结论7．5％高渗盐水有明显的利尿作用，可减少急性弥漫性腹膜炎急诊手术后的输液量和液体正平衡量，促进液体负平衡提前出现，并使总体并发症发生率降低。

Objective To investigate the effects of 7.5% hypertonic saline on fluid balance after emergency laparotomy for acute diffuse peritonitis. Methods Forty-two patients with acute diffuse peritonitis undergoing emergency laparotomy were studied. The patients were assigned to receive either Ringer lactate solution following 4 mL/kg of 7.5% hypertonic saline （the experimental group, n = 21 ） or Ringer lactate solution （the control group, n = 21 ） during the early postoperative period in SICU. Fluid infusion volume,urine outputs,fluid balance,body weight change as wall as the overall incidence of complications and mortality were compared between the two groups. Results Fluid infusion volume on the operative day was significantly less in experimental group than in control group （P 〈 0.05 ）. Urine outputs on the operative day and the first postoperative day in experimental group were significantly more than those in control group （ P 〈 0.05, P 〈 0. 05 ）. The volume of the positive fluid balance on the operative day and the first postoperative day in experimental group was significantly less than in control group （P 〈 0. 01, P 〈 0.01 ）. Body weight gain after emergency laparotomy was significantly less in experimental group than in control group （P 〈 0.01 ）. The overall incidence of complications was lower in experimental group than in control group （P 〈 0.05 ）. Conclusion 7.5% hypertonic saline has an intense diuretic effect,which can reduce fluid infusion volume and positive fluid balance after emergency laparotomy for acute diffuse peritonitis as well as accelerate negative fluid balance appearance more early after emergency laparotomy, and make the overall incidence of complication after emergency laparotomy lower.