成人与儿童乳酸林格氏液液体动力学的比较

A comparison of the volume kinetics of lactated Ringer's solution in children and adults

目的:探讨成人和儿童术前乳酸林格氏液液体动力学的差别。方法:本研究是随机,双盲前瞻性研究。择期盆腔、肛肠或者下肢小手术患者28例,美国麻醉医师协会(ASA)I级,其中儿童14例,成人14例。所有患者给予镇静药后在20 min内恒速输入10 m L/kg的乳酸林格氏液体,通过血红蛋白(Hb)稀释-时间曲线和尿量采用Matlab 4.2软件包计算液体动力学参数。结果:一级动力学模型拟合结果显示,与成人相比,在输入林格氏液体后90 min内儿童的血浆稀释程度明显降低(0.16 vs 0.07,P=0.000),儿童将输入液体的43%通过肾脏排出,显著高于成人(18%)(P=0.011)。按公斤体重计算儿童和成人对乳酸林格氏液的血浆清除率分别是2.2 m L·min-1·kg-1和0.5 m L·min-1·kg-1(P=0.016),而肾脏对乳酸林格氏液体的清除率两组分别是0.76 m L·min-1·kg-1和0.10 m L·min-1·kg-1,(P=0.000)。结论:儿童对乳酸林格氏液体血浆和肾脏清除率分别是成人的4倍和7倍,术前给儿童输液,按照体重计算量可以参照成人的剂量。

AIM： To explore the difference of the volume kinetics of Lactated Ringer＇s Solution between children and adults. METHODS： This was a prospective randomized double-blinded study. Twenty-eight patients including 14 pediatric patients and14 adult patients whose American Society of Anesthesiology Physical Status I（ ASA I） were scheduled for similar minor pelvic,anal rectal,and lower limb surgery. After premedicated with sedative,all patients were given 10 mL / kg of lactated Ringer＇s solution at a constant rate over 20 min. The volume kinetic was calculated by plasma dilution（ based on hemoglobin） and urinary excretion by using Matlab4. 2. RESULTS： The volume kinetics of lactated Ringer＇s solution was described by one-volume kinetic model. Compared with the adults,the plasma dilution within 90 min after infusion of Lactated Ringer＇s Solution was less pronounced in the pediatric patients（ 0. 16 vs 0. 07,P = 0. 000） who also had excreted more of the infused fluid through kidney within 90 min than the adults（ 43% vs 18%,P =0. 011）. After correction for body weight,the plasma clearances for children and adults were 2. 2 and0. 5 mL ·min-1·kg- 1respectively（ P = 0. 016）while their renal clearances of Lactated Ringer＇s Solution were 0. 76 and 0. 10 mL ·min- 1·kg- 1respectively（ P = 0. 000）. CONCLUSION： The plasma and renal clearances of lactated Ringer＇s solution were 4 times and 7 times higher in children in comparison with adults. Therefore,children in this age group may receive at least the same amounts of fluid per kilo body weight during preparation for surgery as the amounts recommended for adults.