子宫肌瘤患者术中快速输注3种不同晶体液对酸碱平衡影响的比较

Effects of intraoperative fast infusion of three kinds of crystalloid fluids on acid-base balance in patients with hysteromyoma

目的 :观察生理盐水 (9g/ L )、复方醋酸钠平衡液、5 0 g/ L葡萄糖生理盐水 3种晶体液对酸碱平衡的影响。方法 :选择子宫肌瘤 36例分为 3组 ,每组 12例 ,A组输注生理盐水 (9g/ L) ,B组输注 5 0 g/ L 葡萄糖生理盐水 ,C组输注复方醋酸钠平衡液。均以 2 0 m L/ (kg·h)速度输注。各组除输上述晶体外无其他任何液体或血液输入 ;术中监测血气、电解质及乳酸浓度的动态变化。结果 :A组与 B组 p H值明显下降 ,而 Na+ 、Clˉ 、碱剩余 (BE)绝对值明显升高。C组各项指标无明显变化。结论 :快速输注生理盐水 (9g/ L)和 5 0 g/ L 葡萄糖生理盐水可产生高氯性代谢性酸中毒 ,而复方醋酸钠平衡液对酸碱平衡的影响极小。

Objective:To study the effects of intraoperative fast infusion of normal saline,compound injection of sodium acetate(Ringer’s solution) and 50 g·L -1 glucose saline on acid-base balance in patients with hysteromyoma.Methods: 36 patients with hysteromyoma were randomly divided into three groups,namely normal saline (group A,n=12),50 g·L -1 glucose saline(group B,n=12) and Ringer’s solution group(group C,n=12).The crystalloid fluids were infused at a speed of 20 mL/(kg·h),and no other fluids or blood was infused simultaneously.The blood gas,electrolytes and the concentration of lactic acid were monitored during operation.Results: The pH value of blood in group A and group B decreased obvioulsy after rapid transfusion,whereas the concentrations of sodium and chloridion,and the absolute value of base excess increased notably.Each index in group C exhibited no difference after rapid transfusion.Conclusion: Fast infusion of normal saline and 50 g·L -1 glucose saline can result in hyperchloremic metabolic acidosis,while Ringer’s solution has little influence on acid-base balance.