醋酸钠林格注射液用于108例手术患者的液体治疗有效性评价

Evaluation of Effectiveness of Sodium Acetate Ringer's Injection Used in Fluid Therapy of 108 Operative Patients

目的评价醋酸钠林格注射液(SARI)用于非心脏手术患者的液体治疗有效性。方法选择接受非心脏手术的患者108例,随机分为对照组和观察组,各54例。对照组患者给予氯化钠注射液(商品名万汶)治疗,观察组患者给予醋酸钠林格注射液治疗,记录两组患者输注前后的血流动力学、动脉血气和电解质等指标。结果两组患者各时间点血流动力学状态,即收缩压、舒张压、平均动脉压、中心静脉压和心率比较,差异均无统计学意义(P>0.05);两组患者输注前血液p H、剩余碱(BE)、HCO3-比较,差异均无统计学意义(P>0.05);输注结束后15 min,观察组的p H,BE,HCO3-变化幅度明显低于对照组,血气指标趋于稳定;两组患者血钾、钙、镁均有明显降低,输注前后组内比较,差异均有统计学意义(P<0.05);两组患者输注前后血钠差值比较,差异无统计学意义;与输注前比较,血氯升高,输注前后组内比较,差异均有统计学意义(P<0.05)。结论醋酸钠林格注射液用于全身麻醉非心脏手术患者能保持循环稳定,对维持血浆电解质和酸碱平衡优于万汶,大量输注无高氯性酸中毒的风险,适用于围术期高容量血液稀释及失血性休克时的容量复苏治疗。

Objective To evaluate the effectiveness of Sodium Acetate Ringer＇s Injection（ SARI） used in the fluid therapy of the patients with non- cardiac surgery. Methods 108 patients with non- cardiac surgery were selected and randomly divided into the control group and the observation group,54 cases in each group. The control group was given Sodium Chloride Injection（ Voluven） and the observation group received SARI. The hemodynamic indexes,arterial blood gas and electrolytes before and after infusion were recorded in the two groups. Results The hemodynamic status at each time point,i. e. systolic blood pressure,diastolic blood pressure,mean arterial pressure,central venous pressure and heart rate,had no statistically significant difference between the two groups（ P 0. 05）; the differences in the blood p H,base excess（ BE）,HCO3-before infusion between the two groups had no statistical significance（ P 0. 05）; the change amplitudes of p H,BE,HCO3-at 15 min after the end of infusion in the observation group were significantly lower than those in the control group,the blood gas indexes trended to be stabilized; the blood potassium,calcium and magnesium in the two groups were significantly decreased,the difference between before and after infusion in the intra- group had statistical significance（ P 0. 05）; the blood sodium in the two groups had no statistical difference between before and after infusion; compared with before infusion,blood chloride was increased,which had statistical difference between before and after infusion in the intra- group（ P 0. 05）. Conclusion SARI used in the patients with non- cardiac surgery under general anesthesia can maintain the circulation stability,is superior to Voluven in maintaining plasma electrolyte and acid- base balance,and has no risk of high chloride acidosis by massive infusion,which is suitable for the capacity recovery therapy in perioperative hypervolemic hemodilution and hemorrhagic shock.