Zhu Guizhou, Li Yuhong, Ru Guomei, Ding Qiannan
Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China.
Medical Research Center, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China.
Exp Ther Med. 2017 Jun;13(6):3146-3152. doi: 10.3892/etm.2017.4329. Epub 2017 Apr 12.
The present study investigated the hemodynamics, vascular and extravascular volume expansion induced by infusion of lactated Ringer's solution in children and adults before surgery. This was a prospective randomized double-blind study. A total of 28 patients (14 children and 14 adult patients; American Society of Anesthesiology status I) scheduled for similar minor pelvic, anal rectal or lower limb surgery were recruited for the present study. All patients were administered with 10 ml/kg of lactated Ringer's solution at a constant rate over 20 min. After fluid infusion, plasma dilutions were calculated based on the concentration of hemoglobin. Heart rate (HR), mean arterial pressure (MAP) and urine output were measured before anesthesia was administered for surgery. Results demonstrated that the plasma dilution within 90 min of infusion initiation of lactated Ringer's solution was less pronounced in children compared with adult patients (0.07 vs. 0.16; P<0.001). Children also excreted more of the infused fluid through the kidney within 90 min of infusion initiation than the adults (55% vs. 24%; P=0.01). Following completion of fluid infusion, the volume expansion efficiency was higher in adults [0.82 (0.52-1.00)] than in children [0.46 (0.26-0.68)]. The relative changes in HR were significantly greater in children than in adults 15-60 min after infusion initiation (P<0.01). After 60 min, HRs were comparable between the groups; however, MAP declined significantly from 25-90 min after infusion initiation in children (P<0.05), yet remained nearly constant in adults (P>0.05). Simple regression analysis revealed a positive relationship between the relative changes in MAP and the plasma dilution, and the reduction in MAP in children was able to explain 47% of the variation in plasma dilution (R=0.47; P=0.007). In conclusion, different hemodynamics and dynamics of fluid shift of Ringer's solution prior to surgery in children and adults may provide anesthesiologists with new information of how to administer fluid treatment for each patient.
本研究调查了手术前输注乳酸林格氏液对儿童和成人血流动力学、血管内及血管外容量扩张的影响。这是一项前瞻性随机双盲研究。本研究共招募了28例计划进行类似的小骨盆、肛门直肠或下肢手术的患者（14例儿童和14例成年患者；美国麻醉医师协会分级为I级）。所有患者均在20分钟内以恒定速率输注10ml/kg的乳酸林格氏液。输液后，根据血红蛋白浓度计算血浆稀释度。在麻醉诱导前测量心率（HR）、平均动脉压（MAP）和尿量。结果表明，与成年患者相比，在输注乳酸林格氏液开始后90分钟内儿童的血浆稀释程度较轻（0.07对0.16；P<0.001）。在输注开始后90分钟内，儿童通过肾脏排出的输注液体也比成人多（55%对24%；P=0.01）。输液结束后，成人的容量扩张效率[0.82（0.52-1.00）]高于儿童[0.46（0.26-0.68）]。在输注开始后15-60分钟，儿童HR的相对变化显著大于成人（P<0.01）。60分钟后，两组之间的HR相当；然而，在输注开始后25-90分钟，儿童的MAP显著下降（P<0.05），而在成人中几乎保持不变（P>0.05）。简单回归分析显示MAP的相对变化与血浆稀释之间呈正相关，儿童MAP的降低能够解释血浆稀释变化的47%（R=0.47；P=0.007）。总之，儿童和成人手术前乳酸林格氏液不同的血流动力学和液体转移动力学可能为麻醉医生提供有关如何对每位患者进行液体治疗的新信息。
