PCNL对患者电解质和血糖的影响

PCNL on patient's electrolyte and blood sugar

目的观察经皮肾镜激光碎石术(PCNL)患者围手术期电解质和血糖的变化,探讨术中补充钾、钙、镁、葡萄糖的必要性。方法选择行PCNL患者60例,随机分成A、B两组,每组各30例,术前适当扩容,术中A组以羟乙基淀粉注射液维持静滴,B组以500mL钠、钾、钙、镁、葡萄糖注射液中加入氯化钾1.2g,葡萄糖15g,维持静滴,在两组患者改俯卧位后,以0.9%氯化钠液灌洗前(T0)、灌洗液冲洗35分钟(T35)、冲洗70分钟(T70),分别采静脉血,测得并记录钾、钠、氯、钙、镁和血糖值。结果 A组患者T35与T0相比钠、氯值升高,差异有显著性(P<0.05),钾、镁、钙、血糖值降低,差异有显著性(P<0.05),T70与T0、T35相比钠、氯值升高,差异有显著性(P<0.05),钾、镁、钙、血糖值降低,差异有显著性(P<0.05);B组患者T35与T0相比钠、氯值升高,差异有显著性(P<0.05),钾、镁、钙、血糖值无明显变化,差异无显著性(P>0.05),T70与T0、T35相比钠、氯值明显升高,差异有显著性(P<0.05),钾、镁、钙、血糖值无明变化,差异无显著性(P>0.05);A组与B组比较,钠、氯值无明显差异,差异无显著性(P>0.05),T0钾、镁、钙、血糖值无明显变化,差异无显著性(P>0.05),T70、T35钾、镁、钙、血糖值B组明显高于A组,差异有显著性(P<0.05)。结论行PCNL患者随麻醉及手术时间的延长、冲洗液用量的增多,血钠、氯逐渐升高,血钾、镁、钙、血糖值逐渐降低,患者宜常规监测离子及血糖,术中宜适当补充钾、镁、钙、血糖,以确保患者的安全。

Objective By observing the changes of electrolyte,blood sugar,to discuss the necessarity of monitoring electrolyte and blood sugar during the perioperation of PCNL for genal anaesthesia patients.Methods 60 patients performed the PCNL were selected,randomly divided into group A and B（n=30）.In group A,hydroxyethyl starch was infused in operation,in group B,500 mL of sodium,potassium,calcium,magnesium and glucose injection by adding 1.2 grams of potassium chloride,15 grams glucose was infused in operation.In two groups of patients,the blood sodium,kalium,sugar,chlorine,calcium,magnesium,were measured after prostate position and before irrigating（T0） by 0.9% sodium chloride,and after irrigating 35min（T35）,75min（T70）.Results In group A,T35 compared with T0,sodium,chloride,was increased,the difference was statistically significant（P0.05）,potassium,magnesium,calcium,blood glucose was decreased,the difference was significant（P0.05）,T70 compared with T0 and T35,sodium,chloride was increased,the difference was statistically significant（P0.05）,potassium,magnesium,calcium,blood glucose was decreased,the difference statistically significant（P0.05）.In group B,T35 compared with T0 sodium,chloride wasincreased,the difference was statistically significant（P 0.05）,the change of potassium,magnesium,calcium,glucose was not obvious,the differenc e was not statistically significant（P 0.05）,T70 compared with T0 and T35,so-dium,chloride,was increased,the difference was statistically significant（P0.05）,the change of potassium,magnesium,calcium,glucose was not obvious,the difference was not statistically significant（P0.05）.G-roup B compared with group A,the change of sodium,chloride,was no significant difference,the difference was not statistically significant（P 0.05）,in T0,the change of potassium,magnesium,calcium,glucose was not obvious,the difference was not statistically significant（P 0.05）,in T35 and T70,the levels of potassium,magnesium,calcium,blood glucose,group B were significantly higher than the group A,the difference was statistically significant（P0.05）.Conclusion PCNL patients with anesthesia and surgery extended,the fluid consumption increased,the values of sodium,chloride,creatinine,urea nitrogen increased gradually,the values of potassium,magnesium,calcium,blood glucose decreased gradually,the electrolyte and glucose should be monitoried in routine,in order to ensure the safety of patients,potassium,magnesium,calcium,glucose should be appropriately added appropriately in PCNL.