醋酸林格氏液与生理盐水在小儿神经外科手术中的应用比较

The Comparison of Plasmalyte and Normal Saline Used in Pediatric Neurosurgery Operation

目的：评价小儿神经外科手术患者应用醋酸林格氏液与生理盐水对血清晶体渗透压、血电解质、血乳酸及血糖的影响。方法：选取择期行颅内占位病变切除的患儿60例,年龄3-6岁,ASAⅠ级或Ⅱ级,按随机数字表法分为两组各30例。A组患儿在诱导前,按照体重kg×5 m L以较快的速度输注醋酸林格氏液,B组患儿在诱导前,按照体重kg×5 m L以较快的速度输注生理盐水,以补充因术前禁食而存在的轻度或中度低血容量。维持量按4：2：1法则计算,并以每搏输出量变异度（SVV）指导6%羟乙基淀粉（130/0.4）的输注量。分别于麻醉诱导前（T1）、剪开硬膜即刻（T2）、手术结束时（T3）监测动脉血气、电解质、乳酸、血糖、尿素氮、肌酐水平,计算血清晶体渗透压。记录各个监测时间点的手术时间、血流动力学指标、总输液量、出血量、尿量。结果：两组手术时间、术中出血量、总输液量、尿量、血清晶体渗透压、血糖及乳酸水平比较差异均无统计学意义（P〉0.05）。T2时刻点,A组血p H值较B组高,差异有统计学意义（P〈0.05）;T2、T3时刻点,A组血氯离子水平较B组低,差异有统计学意义（P〈0.05）。结论：在小儿神经外科手术中,应用醋酸林格氏液较生理盐水无明显渗透压降低,不额外升高血糖,不含钙,可以减少高氯性代谢性酸中毒的产生,是相对安全的液体选择。

Objective：To investigate the comparison of Plasmalyte and normal saline used in pediatric neurosurgery operation.Method：60 patients aged 3-6 years old and ASA Ⅰ or Ⅱ were admitted for an elective operation of intracranial tumours and randomly divided into two groups, 30 cases for each group. Patients in the group A received kg×5 m L Plasmalyte therapy before induction, patients of the group B received kg×5 m L normal saline therapy before induction, supplemented the preoperative fasting that existence of mild or moderated low blood volume. Subsequently, the two groups respectively received fixed rate of physical requirement·h crystalloid, including Plasmalyte and normal saline, based on rule 4：2：1, to the end of the anesthesia. Besides that, Hydroxyethyl starch 6% therapy were given guided by the stroke volume variation（SVV） monitoring. Arterial blood gas analysis was performed before induction of anesthesia（T1）, before dural opening（T2） and end of operation（T3）. Arterial blood sample were taken to detect electrolytes, lactic acid, blood glucose, urea nitrogen, creatinine and calculate serum osmolality at T1-3.Result：There were no significant differences in the time of operation, blood loss, fluid volume, urine volume, serum osmolality, blood glucose, and lactate concentrations of the two groups（P〉0.05）. The group A had significantly increased serum p H value than the group B at T2（P〈0.05）. The group A had significantly decreased chloride concentrations than the group B at T2,T3（P〈0.05）.Conclusion：Plasmalyte which can avoid hyperchloremic metabolic acidosis compared with normal saline as well as not rising blood glucose and decreasing serum osmolality, is more suitable for pediatric patients undergoing intracranial tumor resection.