Hassan Mohamad Hasyizan, Hassan Wan Mohd Nazaruddin Wan, Zaini Rhendra Hardy Mohd, Shukeri Wan Fadzlina Wan Muhd, Abidin Huda Zainal, Eu Chong Soon
Department of Neurosciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Malays J Med Sci. 2017 Oct;24(5):83-93. doi: 10.21315/mjms2017.24.5.9. Epub 2017 Oct 26.
Normal saline (NS) is a common fluid of choice in neurosurgery and neuro-intensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid-base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU.
Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS ( 33) and BF therapy groups ( 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid-base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA.
The NS group showed a significant lower base excess (-3.20 versus -1.35, 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, 0.003) and magnesium (0.94 versus 0.80 mmol/L, 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO, lactate, and sodium level.
BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.
生理盐水（NS）是神经外科和神经重症监护病房（ICU）常用的补液选择，但它不含其他电解质，长时间输注有导致高氯性代谢性酸中毒的风险。平衡液（BF）的出现可能会减少这些问题，平衡液是一种含有完整电解质成分的更符合生理的等渗溶液。本研究旨在比较神经ICU中术后重型创伤性脑损伤（TBI）患者接受NS和BF（Sterofundin® ISO）治疗后电解质和酸碱平衡的变化。
66例需要紧急开颅手术或颅骨切除术且计划术后通气的重型TBI患者被随机分为NS组（33例）和BF治疗组（33例）。维持补液量的计算基于霍利迪-西加尔方法。在24小时内每隔8小时评估一次电解质和酸碱参数。数据采用重复测量方差分析。
治疗24小时时，NS组的碱剩余显著低于BF组（-3.20对-1.35，P = 0.049），碳酸氢盐水平更低（22.03对23.48 mmol/L，P = 0.031），高氯血症更严重（115.12对111.74 mmol/L，P = 0.001），低钾血症更严重（3.36对3.70 mmol/L，P = 0.001）。补液治疗24小时时，BF组的钙水平（1.97对1.79 mmol/L，P = 0.003）和镁水平（0.94对0.80 mmol/L，P = 0.001）显著高于NS组。pH值、二氧化碳分压、乳酸和钠水平无显著差异。
在术后TBI患者的长时间补液治疗中，BF治疗在维持更高的电解质参数和减少高氯性代谢性酸中毒趋势方面比NS治疗效果更好。
