2.5%碳酸氢钠骨髓腔冲洗对股骨柄置入时血流动力学的影响

Effect of flushing the bone marrow cavity with 2.5%sodium bicarbonate can stable hemodynamics during femoral stem placement

目的:观察使用2.5%碳酸氢钠溶液冲洗骨髓腔对股骨柄置入时的血流动力学影响。方法:择期在腰麻下接受股骨头置换的患者141例,在开放骨髓腔后,随机分为2组,SB组70例,使用2.5%生理盐水对骨髓腔进行清洗,NS组71例,使用生理盐水对骨髓腔进行清洗。观察记录开放骨髓腔时(T0),扩张骨髓腔结束时(T1),骨髓腔冲洗结束时(T2),股骨假体柄置入稳定时(T3),股骨头假体复位关节囊关闭完成时(T4)的HR,CVP,MAP。记录手术历时、出血量、输液量以及手术后第二天血常规中白细胞的计数情况。结果:在冲洗骨髓腔后置入股骨柄手术过程中,两组患者均出现了CVP,HR升高,MAP下降的情况,SB组CVP、HR、MAP改变幅度低于NS组。2)SB组白细胞计数明显低于NS组。结论:人工股骨头置换术中,使用碳酸氢钠对骨髓腔进行冲洗,能达到减轻股骨柄置入后的血流动力学波动和术后炎症反应情况。

Objective In artificial femoral head replacement,femoral stem implantation can cause hemodynamic instability.The purpose of this clinical trial is to observe whether washing the bone marrow cavity with 2.5%sodium bicarbonate solution can reduce the Fluctuation hemodynamics during femoral stem implantation.Methods 141 patients undergoing elective artificial femoral head replacement under spinal anesthesia were randomly divided into two groups after femoral marrow cavity was open.In sodium bicarbonate Group(Group SB),2.5% sodium bicarbonate was used to wash the bone marrow cavity,while in normal saline Group(Group NS),normal saline was used to wash the bone marrow cavity.HR,CVP and map were recorded at five time points:At the time of opening the bone marrow cavity(T0),at the end of expanding the bone marrow cavity(T1),at the end of washing the bone marrow cavity(T2),at the time of stable placement of the stem of the hip prosthesis(T3),at the time of complete reduction of the joint capsule of the hip head prosthesis(T4).The cases of patients who reported chest tightness during the operation,the duration of the operation,the amount of blood loss,the amount of fluid infusion,and the count of white blood cells on the day before surgery and on the second day after the surgery were recorded.Results 1)After implantation of the artificial femoral stem into the bone marrow cavity,both patients showed an increase in CVP and a decrease in MAP,which were statistically significant when compared with the data at the previous time points(T0-T3).The magnitude of the change in CVP,HR,and map was smaller in the Group SB than in the Group NS.2)The leucocyte count in Group SB was significantly lower than that in Group NS.Conclusion During the artificial replacement of the head of the hip,instead of normal saline,the bone marrow cavity was washed with 2.5%sodium bicarbonate can reduce hemodynamic fluctuations,and can attenuate postoperative inflammatory response.