醋酸钠林格注射液纠正失血性休克代谢性酸中毒的临床效果

Analysis of the clinical effect of acetate ringers in correcting metabolic acidosis in patients with hemorrhagic shock

目的比较醋酸钠林格注射液与乳酸钠林格注射液对失血性休克患者代谢性酸中毒的影响。方法失血性休克患者50例,按随机数字表法分为醋酸钠林格注射液组(A组)、乳酸钠林格注射液组(L组),每组25例。观察诱导前(T0),诱导后1 h(T1)、2 h(T2)、3 h(T3)、4 h(T4)患者血液p H值、血乳酸值(LAC)、碱剩余(BE),HCO3-值及Na HCO3用量。结果 2组患者在ASA分级、手术时间、术中输入试验晶体液量、失血量这5项指标差异均无统计学意义(P>0.05)。A组在T3时间点较L组p H值显著改善(P<0.05);A组T2时间点LAC值较T0点显著降低(P<0.05),L组T2、T3、T4时间点LAC值较T0点明显升高(P<0.05),且在T2、T3、T4时间点LAC值L组较A组显著升高(P<0.05);Na HCO3用量A组比L组减少(P<0.05);BE值两组间比较无显著差异。结论在失血性休克患者液体复苏过程中,醋酸钠林格注射液可使用更少Na HCO3用量、更快速改善血p H值,降低血乳酸水平。

Objective To compare the effects of acetate ringers solution and lactated ringers solution on metabolic acidosis in patients with hemorrhagic shock. Methods 50 patients with hemorrhagic shock were divided equally into 2 groups randomly（n=25）： the acetate ringers solution（group A） and lactated ringers group（group L）. Changes of arterial blood gas and volume of NaHCO3 before and 1, 2, 3, 4h after induction respectively were observed. Results There were no statistics difference in the ASA grade, operation time, the volume of transfusion during operation and hemorrhage volume of both groups（P﹥0.05）. pH in group A changed at time point of T3 respectively compared to group L（P 〈 0.05）. Serum lactate level（LAC） decreased at T2 compared to T0 time in group A（P 〈 0.05）. LAC level increased at T2, T3, T4 compared to T0 time in group L（P 〈 0.05）. LAC level in group L increased at time point of T2, T3, T4 compared to group A（P 〈 0.05）. Volume of NaHCO3 in group A decreased compared to group L （P 〈 0.05）. Conclusion Acetate ringers solution changes pH, decreases serum lactate level and decreases volume of NaHCO3 during lfuid resuscitation in hemorrhagic shock.