两种不同晶体液预扩容对剖宫产术后炎性反应的影响

Effect of two types of crystalloids on postoperative inflammatory reaction during the process of cesarean section

目的探讨两种不同晶体液预扩容对剖宫产术产妇术后炎性反应的影响。方法选择择期剖宫产产妇60例,随机双盲分为复方乳酸钠组（RL组）和复方醋酸钠组（RA组）,每组30例。麻醉前10 ml/kg晶体液预扩容,输液速率15~20 ml·kg-1·h-1。取左侧卧位行腰-硬联合麻醉。术中持续输入相应晶体液。分别在开始输液时（T1）、手术结束时（T2）、手术后4 h（T3）、24 h（T4）抽取静脉血,检测产妇血清中IL-6、TNF-α和CRP水平。结果 T1、T4时两组产妇CRP、IL-6和TNF-α水平差异无统计学意义。T2、T3时RA组CRP、IL-6和TNF-α水平明显高于RL组（P〈0.05）。结论复方醋酸钠导致产妇术后炎性因子释放的作用明显强于复方乳酸钠。

Objective To study the effects of two types of crystalloids on postoperative inflammatory reaction during the process of cesarean section. Methods Sixty patients undergoing cesarean section were randomly divided into Ringer lactate solution group（ RL） and Ringer acetate solution group（ RA） with30 cases in each group. Before anesthesia,10 ml / kg crystal solution was infused,the infusion rate was 15-20 ml·kg- 1·h- 1. The patients were performed epidural anesthesia in left lateral position. Crystal solution was infused to maintain the blood pressure during the operation. Venous blood was drawn at the beginning of the operation（ T1）,the end of the operation（ T2）,four hours after operation（ T3）,twenty-four hours after operation（ T4） in order to measure the blood plasma value of IL-6,TNF-α,CRP. Results The blood plasma value of IL-6,TNF-α,CRP had no significant differences at T1,T4; but the value of group RA was significantly higher than that of group RL（ P〈0. 05） at T2,T3. Conclusion Ringer acetate solution causes more significant postoperative inflammatory cytokine release than Ringer lactate solution does during the process of cesarean section.