Fösel T H, Uth M, Wilhelm W, Grüness V
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik des Saarlandes, Hornburg/Saar.
Infusionsther Transfusionsmed. 1996 Apr;23(2):80-4. doi: 10.1159/000223263.
Comparison of two commercially available solutions for intraoperative infusion therapy during laparotomies in infants using a standardized anesthetic technique (combination of general anesthesia with a caudal block).
Prospective, randomized.
Infusion therapy during laparotomies in infants.
12 infants aged 1-12 weeks (group I) and 12 infants aged 5-14 months (group II) received at random either solution A with 2.5% glucose and 70 mmol Na+ or solution B with 5.5% glucose and 100 mmol Na+ at a rate of 8 ml/kg/h.
Central venous blood samples after induction of anesthesia and every 60 min for analysis of blood glucose, electrolyte, and hemoglobin concentrations. End of surgery: urine output during the operation and urine glucose and sodium concentrations. Statistical significance within the group: Friedmann Test, between the groups: U test by Wilcoxon, Mann and Witney.
p < 0.05. RESULTS (given as median and range): In group I blood glucose concentrations rose significantly during surgery, however, there was no significant difference between group A or B after 1 h. A: 234 mg/dl (156-351) vs B: 239 mg/dl (166-329)) or 2 h: A: 254 mg/dl (166-331) vs B: 272 mg/dl (176-468). In group II blood glucose levels rose significantly during surgery, however, children of group B showed significantly higher blood glucose levels than group A after 1 h [A: 119 mg/dl (114-227), B: 203 mg/dl (162-238)], 2 h [A: 154 mg/ml (106-185), B: 284 mg/dl (243-317)] or 3 h [A: 159 mg/dl (116-218), B: 248 mg/dl (201-363)]. The plasma and urine sodium concentrations did statistically not differ between the two solutions.
Solutions containing 5.5% glucose infused with 8 ml/kg/h caused in both age groups of infants intolerable hyperglycemias. In young infants, also a solution containing 2.5% glucose infused at a rate of 8 ml/kg/h leads to hyperglycemia, while in older children this amount of glucose is tolerated. It is recommended that for abdominal surgery in young infants glucose and fluid substitution is separated, in order to infuse glucose at an even lower rate. Still, blood glucose levels have to be monitored closely.
采用标准化麻醉技术（全身麻醉联合骶管阻滞），比较两种市售溶液用于婴儿剖腹手术期间术中输液治疗的效果。
前瞻性、随机对照研究。
婴儿剖腹手术期间的输液治疗。
12名1至12周龄的婴儿（I组）和12名5至14月龄的婴儿（II组），随机接受以8 ml/kg/h的速率输注的含2.5%葡萄糖和70 mmol钠的溶液A或含5.5%葡萄糖和100 mmol钠的溶液B。
麻醉诱导后及每隔60分钟采集中心静脉血样，分析血糖、电解质和血红蛋白浓度。手术结束时：记录术中尿量及尿糖和尿钠浓度。组内统计学显著性：Friedmann检验，组间：Wilcoxon、Mann和Witney的U检验。
p < 0.05。结果（以中位数和范围表示）：I组术中血糖浓度显著升高，但1小时后A组和B组之间无显著差异（A组：234 mg/dl（156 - 351），B组：239 mg/dl（166 - 329））或2小时后（A组：254 mg/dl（166 - 331），B组：272 mg/dl（176 - 468））。II组术中血糖水平显著升高，但B组儿童在1小时后血糖水平显著高于A组[A组：119 mg/dl（114 - 227），B组：203 mg/dl（162 - 238）]、2小时后[A组：154 mg/ml（106 - 185），B组：284 mg/dl（243 - 317）]或3小时后[A组：159 mg/dl（116 - 218），B组：248 mg/dl（201 - 363）]。两种溶液的血浆和尿钠浓度在统计学上无差异。
以8 ml/kg/h的速率输注含5.5%葡萄糖的溶液在两个年龄组的婴儿中均导致难以耐受的高血糖症。在小婴儿中，以8 ml/kg/h的速率输注含2.5%葡萄糖的溶液也会导致高血糖，而在较大儿童中这种葡萄糖量是可以耐受的。建议对于小婴儿腹部手术，葡萄糖和液体补充应分开进行，以便以更低的速率输注葡萄糖。尽管如此，仍必须密切监测血糖水平。
