成人与儿童乳酸林格液输注后液体转移分布和心肌耗氧量的比较

Comparison of fluid shift and cardiac oxygen consumption after infusion of Ringer’s solution between adults and children

目的探讨成人和儿童术前乳酸林格液输注期间和输液后,液体转移分布以及心肌耗氧量的差别。方法选取2015年6月至2017年7月浙江大学医学院附属第一医院20例和浙江大学医学院附属儿童医院20例择期盆腔、肛肠或者下肢小手术患者。麻醉镇静后,予乳酸林格液体10 ml/kg,20 min内匀速输注。输液前及输液后50 min内每隔5 min,随后40 min内每隔10 min采集动脉血1 ml,检测Hb水平。根据Hb和尿量计算血浆容量扩张(VE)、血浆扩张效率(VEE)以及血管外容量扩张(EVV),同时以心率和收缩压乘积(RPP)计算心肌耗氧量。结果输液结束时,成人VE为8.18(5.25,9.96)ml/kg,儿童VE为4.55(2.64,6.97)ml/kg,两者均达到峰值,成人组高于儿童组(P=0.011),输液后30 min和60 min,成人VE均高于儿童(均P<0.05);但输液后90 min,两组VE相当(P=0.744)。两组患者不同时点VEE中位数均<1,儿童组(45 min)较成人组(74 min)更快达到晶体液血管内外"4∶1"分布平衡(VE接近20%)(P=0.004)。输液90 min后,留在体内的液体总量儿童低于成人(57%、81%,P=0.015)。儿童输液开始后15 min,成人25 min后,RPP均低于术前基础值(均P<0.05);而输液开始后60 min内,两组RPP相对变化相当,之后成人高于儿童(均P<0.01)。结论术前输注晶体液,液体在血管内外转移分布,儿童和成人存在差异;并且随着液体输注,心肌耗氧量降低。

Objective To investigate the difference of fluid shift and cardiac oxygen consumption during and after preoperative infusion of lactated Ringer’s solution between children and adults.Methods Forty patients undergoing elective pelvic,anorectal or lower limb minor surgery in the First Affiliated Hospital and children’s Hospital of Zhejiang University School of Medicine from June 2015 to July 2017 were enrolled in the study,including 20 adult patients and 20 pediatric patients.After premedication with sedative,all patients were given 10 ml/kg of lactated Ringer’s solution at a constant rate over 20 min.Before and 50 min after infusion,1 mlarterial blood was collected every 5 min and then every 10 min within 40 min.The concentration of hemoglobin(Hb),plasma volume expansion(VE),volume expansion efficiency(VEE),and extravascular volume expansion(EVV)based on the concentration of Hb were detected;and the rate-pressure product(RPP),as an indicator of cardiac oxygen consumption was monitored.Results VE peaked at the end of infusion in both group,at 8.18(5.25,9.96)and 4.55(2.64,6.97)ml/kg in adults and children,respectively(P=0.011).Additionally,at the time points of 30 and 60 min after infusion initiation,the VEs in adults were significantly higher than those in children(P<0.05),but at the time of 90 min post-infusion,the VE measurements in two groups were comparable(P=0.744).The medians of MEEs were all less than 1 in both groups;the infused fluid reached the theoretical"4:1"(with VE approaching 20%)equilibrium of distribution between intra and extravascular space more quickly in children(45 min)compared with adults(74 min,P=0.004).Children also retained less of infused fluid within body90 min post-infusion than adults(57%vs 81%,P=0.015),15 min in children and 25 min in adults following infusion,all RPP values decreased significantly compared to the baseline data(P<0.05).The relative changes in RPP were roughly equivalent in both groups from infusion initiation up to 60 min after infusion.Thereafter,the relative changes in RPP were significantly higher in adults than in children(P<0.01).Conclusion Children and adults disposed of the Ringer’s solution infused prior surgery diffe rently.Cardiac oxygen consumption decreased following the fluid infusion with more decrement in children.