Tellan Guglielmo, Antonucci Adriana, Marandola Maurizio, Naclerio Michele, Fiengo Leslie, Molinari Stefania, Delogu Giovanna
Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Università degli Studi La Sapienza, Roma.
Chir Ital. 2008 Jan-Feb;60(1):33-40.
Intraoperative fluid administration is considered an important factor in the management of metabolic acidosis following surgical procedures. The aim of this study was to compare three types of intraoperative infusional models in order to evaluate their effect on acid-base changes in the immediate postoperative period as calculated by both the Henderson-Hasselbach equation and the Stewart approach. Forty-seven patients undergoing left hemicolectomy were enrolled in the study and assigned randomly to receiving 0.9% saline alone (Group A, n=16), lactated Ringer's solution alone (Group B, n=16) or 0.9% saline and Ringer's solution, 1:1 ratio (Group C, n=15). Arterial blood samples were taken before operation (t0) and 30 min after extubation (t1) in order to measure the acid-base balance. The results showed a metabolic acidosis status in Group A patients, whereas Group B exhibited metabolic alkalosis only by means of the Stewart method. No difference was found in Group C between the time points t0 and t1 when using either the Henderson-Hasselbach equation or using the Stewart model. We conclude that saline solution in association with Ringer's solution (1:1 ratio) appears to be the most suitable form of intraoperative fluid management in order to guarantee a stable acid-base balance in selected surgical patients during the immediate postoperative period.
术中液体输注被认为是手术操作后代谢性酸中毒管理中的一个重要因素。本研究的目的是比较三种术中输注模式，以便通过亨德森-哈塞尔巴赫方程和斯图尔特方法来评估它们对术后即刻酸碱变化的影响。47例行左半结肠切除术的患者纳入本研究，并随机分为单纯接受0.9%生理盐水组（A组，n = 16）、单纯接受乳酸林格氏液组（B组，n = 16）或0.9%生理盐水与林格氏液按1:1比例混合组（C组，n = 15）。在手术前（t0）和拔管后30分钟（t1）采集动脉血样本，以测量酸碱平衡。结果显示，A组患者存在代谢性酸中毒状态，而B组仅通过斯图尔特方法显示存在代谢性碱中毒。使用亨德森-哈塞尔巴赫方程或斯图尔特模型时，C组在t0和t1时间点之间未发现差异。我们得出结论，生理盐水与林格氏液（1:1比例）联合使用似乎是最合适的术中液体管理形式，以便在术后即刻保证选定手术患者的酸碱平衡稳定。
