经皮肾镜取石术中静脉输注糖碱钾液对酸碱平衡、电解质和BNP水平的影响

Effect of intravenous administration of gluco-alkali-potassium solution during percutaneous nephrolithotomy on acid-base balance, electrolyte, and BNP level

目的观察经皮肾镜取石术中静脉输注糖碱钾液对酸碱平衡、电解质和BNP水平的影响。方法 选择2018年1—12月在本院拟行经皮肾镜取石术患者40例,ASAⅠ-Ⅱ,随机分为T组和C组,每组20例。所有患者均选择气管插管下静-吸复合全身麻醉。灌注液选用生理盐水,液压灌注泵持续灌洗,流量200~350ml/min,压力≤2.94kPa(30cmH2O)。灌注期间T组静脉输注糖碱钾液;C组术中静脉输注乳酸钠林格氏液。糖碱钾液配方:5%葡萄糖注射液440ml+5%碳酸氢钠50ml+10%氯化钾10ml。分别在灌注前(T1)、灌注60min(T2)和灌注毕(T3)采集动脉血测定PH、Na+、K+、Cl-、HCO3-、Glu、HCT值;分别在灌注前(T1)、灌注60min(T2)和灌注毕(T3)记录患者的SBP、DBP、HR、CVP值;分别在术前1d和术后1d抽取外周静脉血,检测脑型利钠肽(BNP)和肌钙蛋白T(cTnT)浓度。结果 在T3时点T组的PH、K+、HCO3-、Glu较C组高,差异有统计学意义(P<0.05);T组Cl-较C组低,差异有统计学意义(P<0.05);两组不同时点的SBP、DBP、HR、CVP比较差异无统计学意义(P>0.05);术后1d,T组的BNP浓度低于C组(P<0.05)。结论 经皮肾镜取石术中静脉输注糖碱钾液可以预防因为灌注液吸收所致的代谢性酸中毒和低钾血症,降低术后的BNP水平。

Objective To observe the effect of the intravenous administration of gluco-alkali-potassium solution during percutaneous nephrolithotomy on acid-base balance, electrolyte, and BNP level. Methods Thourty ASA Ⅰ or Ⅱ patients undergoing nephrolithotom were randomly divided into group T and group C, 20 cases for each group. All the patients took general anesthesia with endotracheal intubation. Normal saline was used as the perfusion solution. The hydraulic perfusion pump was used for continuous irrigation with a flow rate of 200-350 ml/min and a pressure of 2.94 kPa (30 cmH2O). During the perfusion period, glucoalkali-potassium solution was administrated intravenously in the group T, and sodium lactate ringer's solution in Group C. The formula for glucone-alkali-potassium solution was 440 ml 5% glucose, 50 ml 5% sodium bicarbonate, and 10 ml 10% potassium chloride. Arterial blood samples were collected for the detdction of pH, Na+, K+, Cl-, HCO3 -, Glu, and HCT as well as the SBP, DBP, HR, and CVP of the patients were recorded before perfusion (T1), after 60 min perfusion (T2), and when perfusion was over (T3). Peripheral venous blood samples were extracted 1 day before and 1 day after surgery to detect the concentrations of brain natriuretic peptide (BNP) and troponin T (cTnT). Results The pH, K+, HCO3 -, and Glu were higher and the Cl- was lower in group T than in group C at T3 (all P < 0.05). There were no statistical differences in SBP, DBP, HR, and CVP between the two groups at all the time points (all P > 0.05). The concentration of BNP was lower in group T than in group C 1 d after surgery (P < 0.05). Conclusion The intravenous administration of gluco-alkali-potassium solution during percutaneous nephrolithotomy can prevent metabolic acidosis and hypokalemia caused by the absorption of perfusion solution and reduce postoperative BNP level.