醋酸钠林格氏液对于神经肿瘤患者术中酸碱平衡及电解质的影响

发布时间：2018-01-25 01:20

本文关键词： 醋酸钠林格氏液生理盐水酸碱平衡电解质　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：比较0.9%氯化钠注射液和醋酸钠林格氏液对神经肿瘤手术患者酸碱平衡和电解质的作用。方法：60例择期行神经肿瘤切除（脑干斜坡区神经肿瘤切除、桥小脑角区肿瘤切除等手术时间较长，出血量相对较少的手术）的患者，ASAII或III级，术前患者心肺功能、肝肾功能正常，电解质正常，无酸碱平衡紊乱。患者术前禁食禁饮8h，随机分成两组，分别为0.9%氯化钠注射液组（NS, n=30）和醋酸钠林格氏液组（SA, n=30）。NS组和SA组在麻醉诱导前15min分别静脉输入8ml/kg预负荷量的0.9%氯化钠注射液和8ml//kg预负荷量的醋酸钠林格氏液。诱导后，两组分别输入20ml/kg的羟乙基淀粉，，此后，NS组用8ml/kg/h的0.9%氯化钠注射液维持，SA组用8ml/kg/h醋酸钠林格氏液维持。分别于入室时（T1）、输入预负荷液体结束后即刻（T2）、3小时（T3）、5小时（T4）对患者行动脉血气分析。统计项目如下：血离子K+、Na+、CI-、Ca2+、Mg2+；血浆pH、Lac、HCO3-；术中总输液量、出血量、尿量、手术时间。麻醉诱导用药为咪达唑仑2mg、顺阿曲库铵0.15mg/kg、芬太尼3μg/kg、丙泊酚2mg/kg。气管插管后行机械通气，并调整呼吸参数：潮气量8ml/kg，氧流量2L/min，呼吸频率12次/min，保持呼气末二氧化碳分压（PETCO2）30~40mmHg。术中麻醉维持为：丙泊酚（5~7mg/kg/h）、瑞芬太尼（3~12μg/kg/h），并间断给顺阿曲库铵。特殊情况处理：术中心率50次/分为心动过缓，上升值超过基础值20%为心动过速，分别使用阿托品、艾司洛尔处理；血压波动超过基础值的20%时，给予血管活性药处理或适当调整麻醉药物输注速度。数据采用SPSS17.0软件进行分析，运用独立样本t检验进行组间比较，运用配对t检验进行组内比较，计数资料比较采用x2检验，计量资料采用均数±标准差（x±s）表示。P＜0.05时有统计学意义。结果：两组患者一般资料（年龄、性别比、体重）差异无统计学意义。两组患者电解质变化：与T1时相比，NS组T3、T4时Cl-浓度显著升高（分别为P0.05，P0.01），SA组各时间点Cl-浓度无明显变化，T4时NS组Cl-浓度显著高于SA组（P0.01）。两组K+、Na+、 Mg2+、Ca2+浓度输液前后无明显变化趋势。输液前后酸碱平衡的变化：与T1时相比，NS组T4时的pH值显著降低（P0.05），SA组各时间pH值无明显变化，T4时SA组pH值显著高于NS组(P0.05)。与T1时相比，NS组T4时HCO3-浓度显著降低（P0.01），SA组各时间点HCO3-浓度无明显变化，T4时SA组HCO3-明显高于NS组（P0.01）。与T1时相比，NS组T3、T4时Lac浓度显著升高（分别为P0.05，P0.01），SA组各时间点Lac浓度无明显变化，T3、T4时NS组Lac明显高于SA组（分别为P0.05，P0.01）。与T1时相比，NS组T3、T4时BE值显著降低（P0.01），SA组T4时BE值显著升高（P0.01）。与NS组相比，SA组在T3、T4时BE值显著升高（P0.01）。结论：对于长时间神经肿瘤手术（脑干斜坡区神经肿瘤切除、桥小脑角区肿瘤切除等手术时间较长，出血量相对较少的手术）患者，长时间输注大量生理盐水，会引起高氯血症及代谢性酸中毒；醋酸钠林格氏液和0.9%氯化钠相比，更不容易引起血浆Cl-浓度升高以及代谢性酸中毒。
[Abstract]:Objective : To compare the effects of 0.9 % sodium chloride injection and sodium acetate in the treatment of acid - alkali balance and electrolyte in patients with nerve tumor . Methods : 60 patients who underwent elective nerve tumor resection ( operation with relatively long operative time and relatively few hemorrhagic volume ) were randomly divided into two groups : 0.9 % sodium chloride injection group ( NS , n = 30 ) and sodium acetate ( SA , n = 30 ) . After induction , 20 ml / kg of sodium chloride injection and 8 ml / kg of sodium acetate were respectively input into the NS group and the SA group . After the induction , two groups were fed with 20 ml / kg of hydroxyethyl starch . After the induction , the groups were maintained with 8 ml / kg / h of 0.9 % sodium chloride injection . The results were as follows : blood ions K + , Na + , CI - , Ca2 + , Mg2 + ; plasma pH , Lac , HCO 3 - ; total infusion volume , blood volume , urine volume and operation time during operation . Anesthesia was induced by midazolam 2 mg , cisplatin 0.15 mg / kg , fentanyl 3 渭g / kg , propofol 2 mg / kg . After tracheal intubation , mechanical ventilation was performed and the breathing parameters were adjusted : tidal volume 8 ml / kg , oxygen flow rate 2 L / min , respiratory rate 12 times / min . Special cases : The center rate of operation was 50 times / time divided into bradycardia , the upper value was higher than the base value of 20 % as tachycardia , and atropine was used alone . The blood pressure fluctuation was more than 20 % of the base value , and the blood vessel active drug was administered or the infusion speed of anesthetic drug was adjusted appropriately . The data were analyzed by SPSS 17.0 software . The comparison between the groups was performed by using the independent sample t test . The comparison between the groups was carried out by using the paired t test , and the count data was compared with the x2 test , and the measurement data was expressed by mean 卤 standard deviation ( x 卤 s ) . The statistical significance was found when P < 0.05 . Results : The general data ( age , sex ratio , weight ) of the two groups had no statistical significance . The concentration of Cl - in NS group was significantly higher than that in SA group ( P0.05 , P0.01 ) . Cl - concentration in NS group was significantly higher than that in SA group ( P0.01 ) . Compared with T1 , the pH value of group NS group was significantly lower than that in NS group ( P0.05 ) . At the time of T4 , the concentration of HCO - 3 - was significantly higher than that in NS group ( P0.05 ) . Compared with NS group , the BE values decreased significantly ( P0.01 ) , and the BE value increased significantly in SA group ( P0.01 ) . In group SA , the BE value increased significantly ( P0.01 ) compared with NS group . Conclusion : Long - term infusion of physiological saline could cause hyperchloraemia and metabolic acidosis , and plasma Cl - concentration and metabolic acidosis were much less likely to cause hyperchloraemia and metabolic acidosis in patients with long - term neuromas operation ( long - term operation with long operation time and relatively fewer hemorrhagic volume ) than those of 0.9 % sodium chloride .

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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