【摘要】 目的研究原位肝移植术中输注醋酸林格氏液(勃脉力A)对酸碱平衡和电解质的影响。方法44例全麻下原位肝移植术中病人,随机分为2组,术中分别静脉输入勃脉力A(PA组)和乳酸林格氏液(LR组)。术中胶体液和血液制品的输入根据血压(BP)、中心静脉压(CVP)和血红蛋白等进行调节。于麻醉前(T1)、门静脉阻断前(T2)、下腔静脉开放后10min(T3)、手术结束时(T4)、术后8小时(T5)、术后24小时(T6)采动脉血测pH、剩余碱(BE)和电解质,根据结果适量输注碳酸氢钠、氯化钾和氯化钙,并分别记录输注的总量。结果两组晶体、胶体液和血液制品输入量无统计学差异(P>0.05)。相比LR组,PA组使用碳酸氢钠的剂量显著降低,氯化钙的剂量显著升高(P<0.05),氯化钾使用剂量无统计学差异(P>0.05)。两组pH、BE在不同时间点的比较,组间、组内比较差异都有统计学意义(P<0.05)。与T1比较,PA组pH、BE在T3下降明显(P<0.05),两组在T5、T6都有升高。术后pH值PA组要比LR组高,但无统计学意义。结论在原位肝移植术中输入醋酸林格氏液有利于动脉血酸碱平衡的稳定,但应相应补充较高剂量钙剂。更多还原

【Abstract】 Objective To compare the effects of Acetated Ringer’s solution and lactated Ringer’s solution on arterial acid-base balance and electrolytes during orthotopic liver transplantation(OLT). Methods Forty-four ASA Ⅱ～Ⅳ patients with end-stage liver diseases undergoing OLT were randomly allocated into 2 groups(n=22 for each):LR group: received lactated Ringer’s solution and PA group: received acetated Ringer’s solution(plasma-lyte A solution; Baxter). The crystalloid solutions were infused at a rate of 6～8 ml/(kg·h). Colloid, albumin, RBC and whole blood were infused based on BP, CVP and Hb. The arterial pH, BE and electrolyte were measured before anesthesia(T1 baseline), before cross-clamping of the portal vein(T2), after unclamping of the portal vein 10 minutes(T3), at the end of surgery(T4), 8 hours after operation(T5) and 24 hours after operation (T6). Sodium bicarbonate, potassium chloride and calcium chloride were infused to balance acid-base and electrolytes and the total dosages were analyzed. Results There were no significant differences in the volume of crystalloid, colloid and blood products infused during operation between 2 groups. The infused volume of potassium chloride in two groups was similar, but infused sodium bicarbonate dosage was significantly lower in group PA and infused calcium chloride dosage was significantly higher in group PA(P<0.05). There was significant difference in arterial pH and BE between and within the 2 groups (P<0.05). The arterial pH and BE decreased significantly at T3 as compared to the baseline value at T1(P<0.05) and increased at T5、T6. Conclusion In perioperative period of OLT, acetated Ringer’s solution had more benefits on acid-base balance than lactated Ringer’s solution except for hypocalcium.更多还原