新生儿坏死性小肠结肠炎术中的液体治疗

Fluid Therapy in Intraoperative Neonatal Necrotizing Enterocolitis

目的评价醋酸钠林格注射液和乳酸钠林格注射液用于新生儿坏死性小肠结肠炎术中液体治疗的有效性和安全性。方法以我院2010年6月—2011年10月收治的坏死性小肠结肠炎行手术治疗的新生儿作为研究对象,采用随机、对照、双盲方法,将患儿分为醋酸钠林格注射液组(AR组)和乳酸钠林格注射液组(LR组),每组25例,所有患儿均接受全麻气管插管,术中维持药物为七氟醚,按照统一的标准进行液体输注,监测患儿术中的平均动脉压、心率、血氧饱和度(SaO2)、酸碱平衡、补液量、尿量等指标,并进行对比分析。结果两组性别、体重、手术时间、液体总量、尿量及患儿手术过程中各时点平均动脉压、心率、SaO2比较差异均无统计学意义(P>0.05);AR组NaHCO3的用量明显少于LR组,差异有统计学意义(P<0.05)。结论醋酸钠林格注射液用于新生儿坏死性小肠结肠炎术中的液体治疗,能有效维持患儿血容量,保持血流动力学稳定,与乳酸钠林格注射液比较能显著改善代谢性酸中毒,在新生儿坏死性小肠结肠炎术中应用更具优势。

Objective To explore the efficiency and safety of sodium acetate ringer＇s injection and sodium lactate ringer＇s injection in treatment of neonatal necrotizing enterocolitis（NNEC）.Methods Neonatus with NNEC were divided into sodium acetate ringer＇s injection group（AR） and sodium lactate ringer＇s injection group（LR） according to random,comparative and double blind methods（n=25）.All patients underwent tracheal cannula under general anesthesia with sevoflurane as intraoperative sustaining medicine.Intraoperative MAP,HR,blood oxygen saturation（SaO2）,acid-base equilibrium,infusion volume and urine volume were detected and compared after unified standard liquid infusion.Results The differences of gender,body weight,duration of surgery,total amount of fluid and urine volume were not statistically significant between the two groups.The differences of mean arterial pressure,heart rate and SaO2 during surgery were not statistically significant between the two groups（P0.05）.The volume of NaHCO3 in AR group was significantly less than that in LR group（P0.05）.Conclusion Sodium acetate ringer＇s injection in treatment of neonatal necrotizing enterocolitis is effective in keeping blood volume and hemodynamics stable;and it has a significant advantage of improving metabolic acidosis during surgery as compared with sodium lactate ringer＇s injection for NNEC.