Sharma Ashima, Yadav Monu, Kumar B Rajesh, Lakshman P Sai, Iyenger Raju, Ramchandran Gopinath
Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Department of Orthopedics, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):532-537. doi: 10.4103/0259-1162.181425.
A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. We prospectively studied the influence of Sterofundin (SF) and Ringer lactate (RL) on acid-base changes, hemodynamics, and readiness for extubation during scoliosis surgery.
Thirty consecutive children posted for scoliosis surgery were randomized to receive either RL ( = 15) or SF ( = 15) as intraoperative fluid at 10 mg/kg/h. Fluid boluses were added according to the study fluid algorithm. Arterial blood was sampled and analyzed at hourly intervals during surgery. Red blood cell transfusion was guided by hematocrit below 27. Patients were followed for 24 h postoperatively in the Intensive Care Unit.
There was no statistically significant difference in the volume of infused fluid (2400 ± 512 ml in Group RL and 2200 ± 640 ml in Group SF. There were no significant changes in pH of patients infused with SF. Statistically, significant higher lactate levels were seen in RL-infused group. The strong ion difference was decreased in both groups, but it normalized earlier with SF.
SF-infused patients had nonremarkable changes in acid-base physiology in scoliosis surgery.
目前对术中输液治疗的麻醉实践有一项重大改变。改用平衡液可大幅降低乳酸酸中毒和高氯性酸中毒的发生率。在大手术期间，不平衡液体的有害影响更易识别。我们前瞻性地研究了复方电解质注射液（SF）和乳酸林格液（RL）对脊柱侧弯手术期间酸碱变化、血流动力学和拔管准备情况的影响。
连续30例拟行脊柱侧弯手术的儿童被随机分为两组，每组15例，分别接受以10mg/kg/h的速度输注RL或SF作为术中液体。根据研究液体算法追加液体冲击量。手术期间每小时采集动脉血样并进行分析。当血细胞比容低于27时进行红细胞输血。患者术后在重症监护病房随访24小时。
两组输注液体量无统计学显著差异（RL组为2400±512ml，SF组为2200±640ml）。输注SF的患者pH值无显著变化。统计学上，RL输注组的乳酸水平显著更高。两组的强离子差均降低，但SF组恢复正常更早。
在脊柱侧弯手术中，输注SF的患者酸碱生理变化不明显。
