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    碳酸氢钠林格液在多节段腰椎手术中的应用效果

    The application effects of sodium bicarbonate Ringer's solution in multi-segment lumbar spine surgery

      摘要
    • 摘要:
      目的： 探讨碳酸氢钠林格液对多节段腰椎手术术中乳酸堆积、酸碱平衡及术后凝血功能的影响。
      方法： 选取全身麻醉下择期行多节段腰椎间盘切除手术病人70例，随机分为乳酸钠林格液组（LRS组）和碳酸氢钠林格液组（BRS组），各35例。比较2组不同时点乳酸（Lac）、pH、碱剩余（BE）、碳酸氢盐（HCO3–）、钾离子（K+）水平和平均动脉压、心率、每搏变异率、心输出量；比较2组术中晶体量、胶体量、液体总量、尿量、出血量以及入PACU至苏醒时间；比较术前及术后24 h活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原。
      结果： 2组病人术中晶体量、胶体量、液体总量、尿量、出血量和苏醒时间差异均无统计学意义（P ＞ 0.05），不同时点平均动脉压、心率、每搏变异率、心输出量差异亦均无统计学意义（P ＞ 0.05）。LRS组术中Lac水平逐渐升高且术毕时明显高于BRS组（P ＜ 0.05）；随手术进行，2组病人BE和pH值均降低（P ＜ 0.05），LRS组HCO3–降低（P ＜ 0.05）。术毕BRS组pH、BE、HCO3–、K＋均高于LRS组（P ＜ 0.05 ~ P ＜ 0.01）。术后24 h，BRS组APTT较术前缩短（P ＜ 0.05），LRS组PT较术前延长（P ＜ 0.05），BRS组PT明显短于LRS组（P ＜ 0.01）。
      结论： 腰椎手术围手术期输注碳酸氢钠林格液有利于维持机体酸碱稳定，降低Lac水平，改善凝血功能。

       

      Abstract:
      Objective To explore the effects of sodium bicarbonate Ringer's solution on intraoperative lactic acid accumulation, acid-base balance and postoperative coagulation function in multi-segment lumbar spine surgery.
      Methods Seventy patients schedulled by multi-segment lumbar discectomy under general anesthesia were selected, and randomly divided into the sodium lactate Ringer's solution group (LRS group) and sodium bicarbonate Ringer's solution group (BRS group) (35 cases each group). The levels of lactate (Lac), pH, base excess (BE), bicarbonate (HCO3–), potassium ion (K+), mean arterial pressure, heart rate, stroke variation rate and cardiac output at different time points were compared between two groups. The intraoperative crystal volume, colloid volume, total fluid volume, urine volume, blood loss volume and time from PACU admission to recovery were compared between two groups. The activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen in two groups were compared between before peration and after 24 hours of operation.
      Results There was no statistical significance in the intraoperative crystal volume, colloid volume, total fluid volume, urine volume, blood loss volume and recovery time between two groups (P ＞ 0.05), and there was no statistical significance in the mean arterial pressure, heart rate, stroke variation rate and cardiac output at different time points in two groups (P ＞ 0.05). The Lac level during the operation in the LRS group gradually increased, and was significantly higher than that in the BRS group at the end of the operation (P ＜ 0.05). With the progress of the operation, the BE and pH values in two groups decreased (P ＜ 0.05), and the HCO3– in the LRS group decreased (P ＜ 0.05). At the end of the operation, the pH, BE, HCO3– and K + in the BRS group were higher than those in LRS group (P ＜ 0.05–P ＜ 0.01). After 24 hours of operation, the APTT in the BRS group was shorter than that before operation (P ＜ 0.05), the PT in the LRS group was longer than that before operation (P ＜ 0.05), and the PT in the BRS group was significantly shorter than that in LRS group (P ＜ 0.01).
      Conclusions The infusion of sodium bicarbonate Ringer's solution during the perioperative period of lumbar spine surgery is beneficial for maintaining the acid-base stability of body, reducing the Lac level, and improving the coagulation function.

       

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