钠钾镁钙葡萄糖注射液对颅脑手术患者内环境及糖、脂肪、蛋白质代谢的影响

Effect of sodium potassium magnesium calcium and glucose injection on internal environment and metabolism of glucose, fat and protein in patients undergoing craniotomy

目的 评价钠钾镁钙葡萄糖注射液对颅脑手术患者内环境及糖、脂肪、蛋白质代谢的影响.方法 择期行开颅手术患者44例,性别不限,年龄18 ～ 64岁,BMI 18～30 kg/m2,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将其分为2组（n=22）：乳酸钠林格液组（R组）和钠钾镁钙葡萄糖注射液组（S组）.于麻醉诱导前以15 ml· kg-1·h-1的速率静脉输注6％羟乙基淀粉130/0.4 30 min,随后按1∶2的比例静脉输注6％羟乙基淀粉130/0.4和相应的晶体液至手术结束,速率5～ 10ml· kg-1·h-1.分别于补液前（基础状态）、手术开始即刻、手术开始后2、4h、术毕及术后1h时采集动脉血样,进行血气分析,记录pH值、BE、Na＋、K＋、Ca2＋、Mg2＋和乳酸浓度,并测定血糖浓度;分别于补液前（基础状态）和术毕时采集静脉血样,测定血浆胰岛素、β-羟丁酸和3-甲基组氨酸的浓度.结果 2组未见高血糖发生;与R组比较,S组Mg2＋浓度升高,乳酸浓度、血浆β-羟丁酸和3-甲基组氨酸的浓度降低（P＜0.05）,其它指标差异无统计学意义（P＞0.05）;与基础值比较,2组血糖浓度升高,R组Mg2＋浓度降低,乳酸、血浆胰岛素、β-羟丁酸和3-甲基组氨酸的浓度升高（P＜0.05）,S组上述指标差异无统计学意义（P＞0.05）.结论 对于颅脑手术患者,钠钾镁钙葡萄糖注射液可较好地维持内环境稳态,其含有的1％葡萄糖可抑制脂肪和蛋白质的分解,且不会引起高血糖和糖代谢紊乱.

Objective To evaluate the effect of sodium potassium magnesium calcium and glucose （SPMCG） injection on the internal environment and metabolism of glucose,fat and protein in the patients undergoing craniotomy.Methods Forty-four patients of both sexes,aged 18-64 yr,of American Society of Anesthesiology Anesthesiologists physical status Ⅰ-Ⅲ,with body mass index of 18-30 kg/m2,were divided into either lactated Ringer＆#39;s solution group （group R） or SPMCG injection group （group S） using a random number table.Before anesthesia induction,6% hydroxyethyl starch 130/0.4 was infused intravenously at 15 ml · kg-1 · h-1 for 30 min,followed by iv infusion of 6% hydroxyethyl starch 130/0.4 and corresponding volume of crystalloid solution in a ratio of 1 ∶ 2 at a rate of 5-10 ml · kg-1 · h-1 until the end of surgery.Before fluid infusion （baseline）,immediately after the beginning of surgery,at 2 and 4 h after the beginning of surgery,at the end of surgery and at 1 h after surgery,arterial blood samples were collected for blood gas analysis,the pH value and concentrations of base excess,Na ＋,K＋,Ca2＋,Mg 2＋and lactic acid were recorded,and the blood glucose concentration was determined.Before fluid infusion （baseline） and at the end of surgery,venous blood samples were taken for determination of the concentrations of plasma insulin,β-hydroxybutyric acid and 3-methylhistidine （3-MH）.Results No hyperglycemia was found in the two groups.Compared with group R,the Mg2＋ concentration was significantly increased,the concentrations of lactic acid and plasma β-hydroxybutyric acid and 3-MH were decreased （P〈0.05）,and no significant change was found in the other parameters in group S （P〉0.05）.Compared with the baseline,the blood glucose concentration was significantly increased after fluid infusion in the two groups,the Mg2＋concentration was significantly decreased,and the concentrations of lactic acid and plasma insulin,β-hydroxybutyric acid and 3-MH were increased after fluid infusion in group R （P〈0.05）,and no significant change was found in the parameters mentioned above in group S （P〉0.05）.Conclusion For the patients undergoing craniotomy,SPMCG injection can maintain homeostasis,and the component 1% glucose can inhibit the decomposition of fat and protein without inducing hyperglycemia and glucose metabolic disorders.