不同晶体液作为洗涤液对婴幼儿心脏术后早期乳酸及电解质的影响

Effects of different crystalloids used as washing solutions on the early postoperative levels of lactic acid and electrolytes in infants undergoing cardiac surgery

目的本研究观察婴幼儿自体血液回收中采用不同晶体液作为洗涤液对心脏手术后患儿早期乳酸水平及电解质的影响。方法选取我院2019年1月至2019年5月行室间隔缺损或房间隔缺损修补术患儿共计60例,随机分为三组。对照组(C组)采用氯化钠注射液为洗涤液。观察组1(W组)采用醋酸钠林格注射液(维力能)为洗涤液。观察组2(L组)采用钠钾钙镁葡萄糖注射液(乐加)为洗涤液。经处理后的洗涤红细胞液均在6小时内全部回输给患儿。记录三组患儿一般资料,包括年龄、体重、性别、CPB时间、主动脉阻断时间及洗涤红细胞量。采用多功能血气分析仪测定洗涤红细胞液(T0)、输注洗涤红细胞液前(T1)、输注洗涤红细胞液完毕(T2)、输注洗涤红细液24小时(T3)血液中乳酸(lactic acid,Lac)、血糖(Glu)、PH值、钾离子(K^(+))、钠离子(Na^(+))、钙离子(Ca2^(+))、氯离子(Cl^(-))浓度。结果三组患儿一般资料包括CPB情况及洗涤红细胞量等对比无统计学差异(P>0.05)。洗涤红细胞液比较:W组、L组pH值及Na^(+)、Cl^(-)浓度与C组比较均有明显下降,pH值、Na^(+)、Cl^(-)分别为[(7.44±0.06)比(7.52±0.10)(P=0.012),(6.87±0.21)比(7.52±0.10)(P<0.001);(124.80±1.15)比(147.05±7.02)(P<0.001),(139.10±3.99)比(147.05±7.02)(P=0.001);(107.10±2.17)比(142.25±8.53)(P<0.001),(107.50±4.79)比(142.25±8.53)(P<0.001)],W组、L组K^(+)、Ca2^(+)、Glu浓度与C组比较均有明显升高,K^(+)、Ca2^(+)、Glu分别为[(4.05±0.15)比(0.84±0.76)(P<0.001),(3.92±0.17)比(0.84±0.76)(P<0.001);(1.23±0.02)比(0.28±0.20)(P<0.001),(0.63±0.03)比(0.28±0.20)(P=0.000);(0.26±0.15)比(0.14±0.05)(P=0.001),(36.30±3.67)比(0.14±0.05)(P<0.001)];W组、L组Lac与C组比较无明显变化(P>0.05)。其余时间点指标比较:L组输注洗涤红细胞后Glu浓度较W、C组比较有明显升高(P<0.05),其余各时间点各指标组间比较均未见明显差异(P>0.05)。结论在婴幼儿心脏手术自体血液回收中采用乐加、维力能作为洗涤液与氯化钠注射液作为洗涤液比较,处理后的洗涤红细胞电解质成份存在明显差异,但输注后对患儿术后早期乳酸及电解质无明显影响。

Objective To observe the effects of different crystalloids as washing solutions in autologous blood recovery on the early postoperative levels of lactic acid and electrolytes in infants undergoing cardiac surgery.Methods From January 2019 to May 2019,a total of 60 infants undergone cardiac surgery in our hospital were enrolled.The patients were randomly divided into three groups including isotonic saline group(group C),sodium acetate Ringer solution group(group W)and sodium potassium magnesium calcium and glucose solution group(group L).The salvaged red blood cell solutions were completely returned to infants within 6 hours.The baseline characteristics of these three groups of infants including age,weight,gender,cardiopulmonary bypass time,aortic cross-clamp time and the volumes of salvaged red blood cell solutions were collected.The levels of lactic acid,glucose,PH value,K^(+),Na^(+),Ca^(2+),and Cl^(-)were determined in salvaged red blood cell solutions and in infant blood before the infusion of salvaged red blood cell solutions(T1),at the end of the infusion of salvaged red blood cell solutions(T2)and at 24 hours after the infusion of salvaged red blood cell solutions(T3)by a multifunctional blood gas system.Results There were no significant differences in the baseline characteristics among these three groups(P>0.05).In the salvaged red blood cell solution.the PH values and the concentrations of Na^(+)and Cl^(-)were decreased in group W and group L compared with group C[PH:group W vs.group C,7.44±0.06 vs.7.52±0.10.P=0.012;group L vs.group C,6.87±0.21 vs.7.52±0.10,/J<0.001;Na':group W vs.group C,(124.80±1.15)mmol/L vs.(147.05±7.02)mmol/L,P<0.001;group L vs.group C,(139.10±3.99)mmol/L vs.(147.05±7.02)mmol/L,P=0.001;Cl:group W vs.group C,(107.10±2.17)mmol/L vs.(142.25±8.53)mmol/L.P<0.001;group L vs.group C,(107.50±4.79)mmol/L vs.(142.25±8.53)mmol/L.P<0.001.Moreover.there was an increase in the concentrations of K^(+),Ca^(2+)and glucose in group W and group L compared with group C[K:group W vs.group C,(4.05±0.15)mmol/L vs.(0.84±0.76)mmol/L,P<0.001;group L vs.group C,(3.92±0.17)mmol/L vs.(0.84±0.76)mmol/L,P<0.001;Ca^(2+)group W vs.group C,(1.23±0.02)mmol/L vs.(0.28±0.20)mmol/L,P<0.001;group L vs.group C,(0.63±0.03)mmol/L vs.(0.28±0.20)mmol/L,P<0.001;glucose:group W vs.group C,(0.26±0.15)mmol/L vs.(0.14±0.05)mmol/L.P=0.001;group L vs.group C,(36.30±3.67)mmol/L vs.(0.14±0.05)mmol/L,P<0.001.There was no signified nt differe nee in blood lactic acid among three groups.After the infusion of salvaged red blood cell solutions,the levels of glucose in group L were significantly higher than those in group C and group W(P<0.05).There were no statistically significant differences in lactic acid,glucose.PH value,K^(+),Na^(+),Ca^(2+)and Cl levels among those three groups at other time points(/9>0.05).Conclusion As washing solutions in autologous blood recovery,compared with isotonic saline,sodium acetate Ringer solution and sodium potassium magnesium calcium and glucose solution can lead to significant differences of the electrolytes in salvaged red blood cell solutions,but have no significant effects on the levels of lactic acid and electrolytes in infant blood in the early postoperative period.