Scheingraber S, Boehme J, Scharbert G, Dralle H
Department of Surgery, University Hospital, Homburg/Saar, Halle/Saale, Germany.
Anaesth Intensive Care. 2004 Oct;32(5):637-43. doi: 10.1177/0310057X0403200505.
This prospective clinical study was performed to determine acid-base regulating variables during abdominal lavage treatment for patients with severe peritonitis or after abdominal surgery. Arterial blood was sampled from twelve patients with secondary peritonitis and nine patients after abdominal surgery without peritonitis at three time points: immediately before, immediately after and 15 minutes after abdominal lavage with normal saline solution. The total amount of irrigant fluid, the strong ion difference [(Na+ + K+)-(Cl- + lactate-)], and total protein concentrations were determined and standard bicarbonate, standard base excess were calculated from pH and PaCO2. Peritonitis patients developed a moderate alkalaemia (pH 7.440-7.485). The alkalaemia was unmasked after optimization of mild hypoventilation, but was supported by a decrease in protein concentration of about 3.4 mEql/l in the first 15 minutes after the lavage. There was no marked increase in chloride concentration in either the peritonitis or the control group. The data indirectly exclude major fluid absorption during abdominal lavage with 3000 to 6000 ml normal saline, given that we found no clinically relevant electrolyte and acid-base changes that might be expected after rapid fluid absorption. The factors of major influence in acid-base regulation were ventilation and protein loss in the course of abdominal lavage. Monitoring of the Stewart variables is an easily applicable method of monitoring acid-base regulating variables in the perioperative course of patients undergoing abdominal lavage therapy.
本前瞻性临床研究旨在确定重症腹膜炎患者或腹部手术后进行腹腔灌洗治疗期间的酸碱调节变量。在三个时间点采集了12例继发性腹膜炎患者和9例无腹膜炎的腹部手术后患者的动脉血：腹腔用生理盐水灌洗前即刻、灌洗后即刻和灌洗后15分钟。测定灌洗液总量、强离子差[（Na⁺ + K⁺）-（Cl⁻ + 乳酸⁻）]和总蛋白浓度，并根据pH值和PaCO₂计算标准碳酸氢盐、标准碱剩余。腹膜炎患者出现中度碱血症（pH 7.440 - 7.485）。轻度通气不足纠正后碱血症显现，但灌洗后最初15分钟内蛋白质浓度降低约3.4 mEql/l支持了碱血症。腹膜炎组和对照组的氯离子浓度均无明显升高。鉴于我们未发现快速液体吸收后可能预期的临床相关电解质和酸碱变化，数据间接排除了用3000至6000 ml生理盐水进行腹腔灌洗期间的大量液体吸收。腹腔灌洗过程中酸碱调节的主要影响因素是通气和蛋白质丢失。监测Stewart变量是一种在接受腹腔灌洗治疗患者围手术期过程中监测酸碱调节变量的易于应用的方法。
