碳酸氢钠林格液用于心脏手术体外循环的效果

Efficacy of bicarbonate Ringer′s solution applied in cardiopulmonary bypass in cardiac surgery

目的评价碳酸氢钠林格液用于心脏手术体外循环(CPB)的效果。方法选取CPB下行心脏瓣膜置换术患者60例,性别不限,年龄55~75岁,采用随机数字表法分为2组(n=30):复方电解质注射液组(A组)和碳酸氢钠林格液组(B组)。A组预充晶体液为复方电解质注射液1500 ml,B组预充晶体液为碳酸氢钠林格液1500 ml,2组预充胶体液均为琥珀酰明胶1000 ml。于复温阶段进行零平衡超滤,A组置换液为复方电解质注射液2000 ml,B组置换液为碳酸氢钠林格液2000 ml。CPB过程中静脉贮血罐内持续滴注碳酸氢钠溶液,根据血气分析结果纠正酸碱平衡紊乱。分别于CPB转流前、转流30 min、开放升主动脉补充钙剂后5 min、零平衡超滤结束即刻和停机后5 min时,抽取外周静脉血或氧合器内氧和静脉血行血气分析。于零平衡超滤开始前和结束后抽取氧合器内氧和静脉血,检测红细胞渗透脆性和2,3-二磷酸甘油酸浓度。结果与A组比较,B组转流30 min和零平衡超滤结束时PaCO_(2)、Ca^(2)+和HCO_(3)^(-)浓度升高(P<0.05),pH值、BE、Glu、Lac、血清Na^(+)、Cl^(-)和K^(+)浓度、红细胞渗透脆性和2,3-二磷酸甘油酸浓度比较差异无统计学意义(P>0.05)。结论碳酸氢钠林格液可安全有效地用于心脏手术CPB。

Objective To evaluate the efficacy of bicarbonate Ringer′s solution applied in cardiopulmonary bypass(CPB)in cardiac surgery.Methods Sixty patients of both sexes,aged 55-75 yr,undergoing cardiac valve replacement under CPB,were selected and randomly divided into compound electrolyte solution group(group A,n=30)and bicarbonate Ringer′s solution group(group B,n=30).Group A was primed with 1500 ml compound electrolyte solution,group B was primed with 1500 ml bicarbonate Ringer′s solution,and both groups were primed with 1000 ml succinylated gelatin.Zero-balanced ultrafiltration was carried out during the rewarming stage.The replacement solution was compound electrolyte solution 2000 ml in group A,and the replacement solution was bicarbonate Ringer′s solution 2000 ml in group B.Sodium bicarbonate solution was continuously dripped into an intravenous blood storage tank during CPB,and the acid-base balance disorder was corrected according to the results of blood gas analysis.The peripheral venous blood samples or venous blood samples from the oxygenator were obtained for blood gas analysis before CPB,at 30 min of CPB,at 5 min after opening the ascending aorta for calcium supplementation,at the end of zero-balanced ultrafiltration,and at 5 min after termination of CPB.Venous blood samples were collected from the oxygenator before the start of zero-balanced ultrafiltration and at the end of zero-balanced ultrafiltration for determination of erythrocyte osmotic fragility and concentrations of 2,3-diphosphoglycerate.Results Compared with group A,PaCO_(2),Ca^(2+)and HCO_(3)^(-)concentrations were significantly increased at 30 min of CPB and at the end of zero-balanced ultrafiltration(P<0.05),and no significant change was found in pH value,BE,Glu,Lac,serum Na^(+),Cl^(-)and K^(+)concentrations,erythrocyte osmotic fragility and concentration of 2,3-diphosphoglycerate in group B(P>0.05).Conclusion Bicarbonate Ringer′s solution can be safely and effectively used for CPB in cardiac surgery.