本文關鍵詞： 醋酸鈉林格氏液 生理鹽水 酸堿平衡 電解質　出處：《吉林大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：比較0.9%氯化鈉注射液和醋酸鈉林格氏液對神經(jīng)腫瘤手術患者酸堿平衡和電解質的作用。 方法：60例擇期行神經(jīng)腫瘤切除（腦干斜坡區(qū)神經(jīng)腫瘤切除、橋小腦角區(qū)腫瘤切除等手術時間較長，出血量相對較少的手術）的患者，ASAII或III級，術前患者心肺功能、肝腎功能正常，電解質正常，無酸堿平衡紊亂。患者術前禁食禁飲8h，隨機分成兩組，分別為0.9%氯化鈉注射液組（NS, n=30）和醋酸鈉林格氏液組（SA, n=30）。NS組和SA組在麻醉誘導前15min分別靜脈輸入8ml/kg預負荷量的0.9%氯化鈉注射液和8ml//kg預負荷量的醋酸鈉林格氏液。誘導后，兩組分別輸入20ml/kg的羥乙基淀粉，，此后，NS組用8ml/kg/h的0.9%氯化鈉注射液維持，SA組用8ml/kg/h醋酸鈉林格氏液維持。分別于入室時（T1）、輸入預負荷液體結束后即刻（T2）、3小時（T3）、5小時（T4）對患者行動脈血氣分析。統(tǒng)計項目如下：血離子K+、Na+、CI-、Ca2+、Mg2+；血漿pH、Lac、HCO3-；術中總輸液量、出血量、尿量、手術時間。 麻醉誘導用藥為咪達唑侖2mg、順阿曲庫銨0.15mg/kg、芬太尼3μg/kg、丙泊酚2mg/kg。氣管插管后行機械通氣，并調整呼吸參數(shù)：潮氣量8ml/kg，氧流量2L/min，呼吸頻率12次/min，保持呼氣末二氧化碳分壓（PETCO2）30~40mmHg。術中麻醉維持為：丙泊酚（5~7mg/kg/h）、瑞芬太尼（3~12μg/kg/h），并間斷給順阿曲庫銨。 特殊情況處理：術中心率50次/分為心動過緩，上升值超過基礎值20%為心動過速，分別使用阿托品、艾司洛爾處理；血壓波動超過基礎值的20%時，給予血管活性藥處理或適當調整麻醉藥物輸注速度。 數(shù)據(jù)采用SPSS17.0軟件進行分析，運用獨立樣本t檢驗進行組間比較，運用配對t檢驗進行組內比較，計數(shù)資料比較采用x2檢驗，計量資料采用均數(shù)±標準差（x±s）表示。P＜0.05時有統(tǒng)計學意義。 結果：兩組患者一般資料（年齡、性別比、體重）差異無統(tǒng)計學意義。 兩組患者電解質變化：與T1時相比，NS組T3、T4時Cl-濃度顯著升高（分別為P0.05，P0.01），SA組各時間點Cl-濃度無明顯變化，T4時NS組Cl-濃度顯著高于SA組（P0.01）。兩組K+、Na+、 Mg2+、Ca2+濃度輸液前后無明顯變化趨勢。 輸液前后酸堿平衡的變化：與T1時相比，NS組T4時的pH值顯著降低（P0.05），SA組各時間pH值無明顯變化，T4時SA組pH值顯著高于NS組(P0.05)。與T1時相比，NS組T4時HCO3-濃度顯著降低（P0.01），SA組各時間點HCO3-濃度無明顯變化，T4時SA組HCO3-明顯高于NS組（P0.01）。與T1時相比，NS組T3、T4時Lac濃度顯著升高（分別為P0.05，P0.01），SA組各時間點Lac濃度無明顯變化，T3、T4時NS組Lac明顯高于SA組（分別為P0.05，P0.01）。與T1時相比，NS組T3、T4時BE值顯著降低（P0.01），SA組T4時BE值顯著升高（P0.01）。與NS組相比，SA組在T3、T4時BE值顯著升高（P0.01）。 結論：對于長時間神經(jīng)腫瘤手術（腦干斜坡區(qū)神經(jīng)腫瘤切除、橋小腦角區(qū)腫瘤切除等手術時間較長，出血量相對較少的手術）患者，長時間輸注大量生理鹽水，會引起高氯血癥及代謝性酸中毒；醋酸鈉林格氏液和0.9%氯化鈉相比，更不容易引起血漿Cl-濃度升高以及代謝性酸中毒。
[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 鹵 standard deviation ( x 鹵 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 .

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R739.41

【參考文獻】

相關期刊論文 前1條

1 陳明慧;何亮亮;楊建軍;徐建國;;生理鹽水與復方醋酸鈉對患者酸堿、電解質及腎功能的影響[J];臨床麻醉學雜志;2008年05期

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