血液回收技术中应用钠钾镁钙葡萄糖注射液对肝肾功能和血气指标的影响

Effect of sodium, potassium, magnesium and calcium glucose injection on hepatic and renal function and blood gas index in blood recovery technology

目的评价钠钾镁钙葡萄糖注射液应用于血液回收技术中对患者肝肾功能和血气指标的影响。方法选择需行血液回收的神经外科手术患者60例,男31例,女29例,年龄19~67岁,BMI 21~25 kg/m^2,ASA Ⅰ或Ⅱ级。随机分为钠钾镁钙葡萄糖注射液组(N组)和生理盐水组(C组),每组30例。N组肝素冲管液采用低分子肝素钠25 000 IU加入钠钾镁钙葡萄糖注射液500 ml中配置,洗涤液全部应用钠钾镁钙葡萄糖注射液;C组肝素冲管液采用低分子肝素钠25 000 IU加入生理盐水500 ml中配置,洗涤液全部应用生理盐水。于血液回收前(T0)、自体血输注完毕后(T1)、手术后6 h(T2)采集血样,检测ALT、AST、血清总胆红素(TBIL)、肌酐(Scr)、尿素氮(BUN)等肝肾功能指标;血氧饱和度50%时的氧分压(P50)、pH、血浆HCO3^-、乳酸(Lac)、电解质(K^+、Na^+、Cl^-、Ca^2+)、血糖(Glu)浓度等血气指标。结果与T0时比较,T1时C组BUN、Scr、Lac、Na^+、Cl^-、Glu浓度明显升高(P<0.05),P50明显升高(P<0.05),pH和血浆HCO3-浓度以及K^+、Ca^2+浓度明显降低(P<0.05)。与T1时比较,T2时C组BUN、Scr、Lac、Na^+、Cl^-、Glu浓度明显升高(P<0.05),P50明显升高(P<0.05),pH和血浆HCO3^-浓度以及K^+、Ca^2+浓度明显降低(P<0.05)。与N组比较,T1和T2时C组BUN、Scr、Lac、Na^+、Cl^-、Glu浓度明显升高(P<0.05),P50明显升高(P<0.05),pH和血浆HCO3^-浓度以及K^+、Ca^2+浓度明显降低(P<0.05)。两组不同时点AST、ALT、TBIL浓度差异无统计学意义。结论在血液回收中应用钠钾镁钙葡萄糖注射液配置肝素冲管液和洗涤液有利于减轻红细胞的损伤,改善红细胞携氧能力,维持内环境稳定和酸碱平衡,有利于保护患者肾功能,但对肝功能无明显影响。

Objective To evaluate the effects of sodium, potassium, magnesium and calcium gluose injection on liver and renal function and blood gas parameters in patients with blood recovery technology. Methods Sixty patients with neurosurgery requiring blood recovery, 31 males and 29 females, aged 19 - 67 years, BMI 21 - 25 kg / m^2 , falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into sodium, potassium, magnesium and calcium glucose injection group (group N) and 0. 9% sodium chloride injection group (group C), 30 cases in each group. Group N heparin rushing liquid was prepared by adding 25 000 IU of low molecular weight heparin sodium to 500 ml of sodium, potassium, magnesium and calcium glucose injection. The washing liquid was all applied with sodium, potassium, magnesium and calcium glucose injection;group C heparin rushing liquid was added with low molecular weight heparin sodium 25 000 IU. The sodium chloride injection was placed in 500 ml, and the washing solution was all applied with 0.9% sodium chloride injection. Before blood recovery (T0 ), after autologous blood transfusion (T1 ), and postop-erative 6 h (T2 ), all the following information were detected: alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum total bilirubin (TBIL), creatinine ( Scr), urea nitrogen (BUN), oxygen partial pressure (P50 ), pH, plasma HCO3^-, lactic acid (Lac), electrolyte (K^+, Na^+, Cl^-, Ca^2+), and blood glucose (Glu) at 50% oxygen saturation. Results Compared with T0 , the concentrations of BUN, Scr, Lac, Na^+, Cl^- and Glu in group C at T1 were significantly increased (P < 0. 05), P50 was significantly increased (P < 0. 05), pH and plasma HCO3^- concentration, K^+, Ca^2+ concentration was significantly reduced (P < 0. 05). Compared with T1 , the concentrations of BUN, Scr, Lac, Na^+, Cl^- and Glu in group C at T2 were significantly increased (P < 0. 05), P50 was significantly increased (P < 0. 05), pH and plasma HCO3^- concentration, K^+, Ca^2+ concentration was significantly reduced (P < 0. 05). Compared with group N, the concentrations of BUN, Scr, Lac, Na^+, Cl^- and Glu in group C were significantly increased (P < 0. 05), P50 was significantly increased (P < 0. 05), pH and plasma HCO3^- concentration at T1 and T2 . The concentrations of K^+ and Ca^2+ were significantly decreased ( P < 0. 05 ). There were no significant differences in AST, ALT, and TBIL between the two groups at different time points. Conclusion The use of sodium, potassium, magnesium and calcium glucose injection in blood recovery to configure heparin flushing fluid and washing solution is beneficial to reduce the damage of red blood cells, improve the oxygen carrying capacity of red blood cells, maintain the stability of the internal environment and the acid-base balance, and help protect the renal function of patients, but no significant effect exerts on liver function.