两种晶体预充液对儿童心肺转流术中血糖及乳酸的影响

Effects oftwo kinds of crystals priming on levels of glucose and lactic acidin pediatrics with cardiopulmonary bypass during congenital heart surgery

目的：比较钠钾镁钙葡萄糖注射液与乳酸林格液对小儿先天性心脏病手术中的血糖及乳酸的影响。方法：体外循环（CPB）下行室缺或房缺修补术儿童60例，年龄1～6岁，体重8-20kg，ASAⅡ～Ⅲ级，随机分为乳酸钠林格液预充组（R组）和钠钾镁钙葡萄糖注射液顸充组（L组）。分别于麻醉诱导后（T1）、阻断主动脉后（rr2）、停机前（L）、关胸后（T4）测定患儿动脉血气、乳酸（Lac）、血糖（Glu）、电解质。结果：两组血糖及乳酸在CPB后均升高（P〈0．01），在T2、T3时点L组乳酸低于R组（P〈0．05），血糖高于R组（P〈0．01），而T4时两组乳酸及血糖均无统计学差异（P〉0．05）。结论：钠钾镁钙葡萄糖注射液作为儿童CPB晶体预充液，能提供能量底物，降低乳酸浓度，对电解质及血气影响小，其预充效果优于乳酸林格液。

Objective To compare the effect of Acetate Sodium Potassium Magnesium Calcium and lactate ringers＇ as priming solution in pediatrics with cardiopulmonary bypass （CPB） during congenital heart surgery. Methods Sixty children, aged 1-6 years, weighting 8 to 20 kg, with ASA Ⅱto Ⅲ class and with ventrieular or atrial septal defect elective, received heart surgery with CPB. They were randomly divided into two groups： the lactate ringers＇ group （R） and the sodium acetate, potassium, magnesium and calcium glucose injection pre-filled group （L）. Levels of artery blood gas, lactic, gluclose, electrolytes were detected at the time points of induction of anesthesia （TI）, aortic cross damping （T2）, stopping before （T3）, and closing chest later （T4）. Results Levels of the blood glucose and lactic acid in the two groups post-CPB were increased （P 〈 0.01） at T2 and T3. Lactic acid level in group L was lower than that in group R （P 〈 0.05）, and the blood glucose level in group L was higher than that in group R （P 〈 0.01 ）. No significant difference was found in the lactic acid and blood glucose post-closing chestbetween the two groups （P 〉 0.05）. Conclusion Sodium, potassium, magnesium, calcium and glucose injection as children CPB priming crystalloid fluid could provide energy substrate, reduce lactic acid concentration, with little effect on electrolyte and blood gas.