混合糖电解质注射液在择期便秘外科手术患者术后补液中的应用

目的探究混合糖电解质注射液在择期便秘外科手术患者术后应用是否能够稳定血糖、减轻乳酸堆积、补充血电解质。 方法筛选2013年11月至2014年1月有明确诊断的64例择期便秘外科手术患者,随机分为试验组（33例）和对照组（31例）,分别给予混合糖电解质注射液和10%葡萄糖电解质注射液。术后连续输注3 d,每天1 000 ml,不足部分按需补充。监测患者手术前和手术后3 d每次输液前后的血糖、乳酸水平及钙、镁、磷离子水平。 结果受试者均未出现相关不良反应或肝肾功能损害。两组患者手术后的血糖与手术前相比均有所升高,但在各时间点及各时间点与手术前的差值之间差异并无统计学意义,但对照组的血糖波动范围较大,试验组的血糖水平相对较为平稳。两组患者的血乳酸、血钙、血镁水平差异无统计学意义。自术后第2天起,试验组血磷水平明显高于对照组,术后第1天输液后至第3天输液前两组血磷水平均低于正常范围;而术后第3天输液后,试验组血磷水平恢复至正常范围,而对照组仍低于正常范围（P<0.05）。 结论择期便秘外科手术患者术后应用混合糖电解质注射液治疗既能对血糖水平有稳定作用,又能对血磷进行补充,是目前临床液体治疗的优先选择。     

瑞恤定在闭合性股骨骨折术后补液的应用

目的 研究瑞恤定[复方右旋糖酐(40)注射液]在闭合性股骨骨折术后补液的应用价值.方法 123例患者随机分为实验组(72例)和对照组(51例),实验组术后输瑞恤定,对照组术后输右旋糖酐(40)葡萄糖注射液,1000 m1/d,连续5d,不足的液体及电解质按患者需要补充.监测患者术后生命体征、不良反应及输液5d后血电解质、血糖、血液流变学及凝血功能的变化.结果 所有患者术后生命体征平稳.实验组1例,对照组4例出现不良反应.两组患者术后5d血K+、C1-、Ca2+的正常率均相近,差异无统计学意义(P＞0.05),血清Na+和血糖差异有统计学意义(P＜0.05).两组患者血液流变学及凝血功能差异有统计学意义(P＜0.05).结论 术后患者应用瑞恤定,既能补充血容量,降低电解质和酸碱平衡紊乱的危险性,对血糖水平作用较小,又能降低血液黏滞度,改善微循环,延长凝血时间,降低血栓形成的风险.     

混合糖电解质注射液在危重病患者中的应用

危重病患者常常需要补液治疗,且危重病患者存在的应激状态,使机体糖代谢发生改变,存在胰岛素抵抗.传统的葡萄糖氯化钠注射液在危重病患者使用中存在着许多缺陷,如高血糖等.混合糖电解质注射液是由葡萄糖、果糖、木糖醇及电解质按一定比例配制的复方营养型输液,我们对2007年12月至2008年3月本院ICU收治的需补液治疗的60例危重病患者中使用混合糖电解质注射液,观察其在血糖控制及电解质代谢方面变化,报告如下.     

钠钾镁钙葡萄糖注射液扩容对术中血糖、电解质和酸碱平衡的影响

目的比较钠钾镁钙葡萄糖注射液和复方乳酸钠注射液扩容对术中血糖、电解质及酸碱平衡的影响。方法择期行胃肠道手术患者30例,采用随机数字法分为研究组(n=16)和对照组(n=14),研究组使用钠钾镁钙葡萄糖注射液扩容,对照组使用复方乳酸钠注射液扩容,分别在入室后以15ml·kg-1·h-1的速度输注相应液体。分别于输液前(T0)、输液量为10ml/kg(T1)、20ml/kg(T2)和30ml/kg(T3)时检测患者血糖、血乳酸、电解质及pH值等。结果输液后研究组血糖明显升高(P<0.05),血乳酸无明显变化,血pH明显降低(P<0.05);对照组血乳酸明显升高(P<0.05);两组电解质水平均无明显变化。结论钠钾镁钙葡萄糖注射液在扩容、维持电解质及酸碱平衡方面与复方乳酸钠注射液效果相当,可避免大量输入复方乳酸钠注射液所致的乳酸升高,但当大量输注钠钾镁钙葡萄糖注射液时可导致一定程度的血糖升高。     

钠钾钙镁葡萄糖注射液用于骨科创伤患者手术的安全性

目的以乳酸钠林格注射液为对照,验证钠钾钙镁葡萄糖注射液用于骨科创伤患者手术的安全性。方法选下肢骨科创伤患者40例,ASA分级Ⅰ-Ⅱ级,随机分为试验组和对照组,试验组使用钠钾钙镁葡萄糖注射液,对照组使用乳酸钠林格注射液。两组均检测入室后输液前(T1)、输液后麻醉操作前(T2)、术毕(T3)、术毕后2 h(T4)患者血糖及电解质,并与入室前基础值(T0)比较,2组间比较.记录过敏及其他不良反应。结果在麻醉手术开始后,2组血糖水平都有升高,试验组和对照组血糖水平均随输注试验液体量的增加逐渐上升,T1、T2、T3与T0比较,差异有统计学意义(P﹤0.05),但均未超过15 mmol/L,在手术结束2 h后基本恢复至术前水平,2组间比较并差异无统计学意义(P>0.05)。2组间电解质浓度并无明显改变。结论钠钾钙镁葡萄糖注射液用于骨折创伤患者的疗效和安全性与乳酸钠林格注射液相当。与乳酸钠林格注射液相比,钠钾钙镁葡萄糖注射液并没有显著增加血糖水平。     

钠钾镁钙葡萄糖注射液术中输注对患者肝肾功能、血电解质、血糖、血乳酸及凝血功能的影响

目的 评估钠钾镁钙葡萄糖注射液（sodium potassium magnesium calcium and glucose,SPMCG）术中输注对患者肝肾功能、血电解质、血糖、血乳酸及凝血功能的影响.方法 择期拟在全身麻醉下行普外科或骨科手术的患者80例,美国麻醉医师协会（ASA）分级Ⅰ级～Ⅱ级,采用随机数字表法分为实验组和对照组,每组40例.实验组给予SPMCG,对照组给予乳酸钠林格注射液.两组均以15 ml·kg-1·h-1的速度输注500 ml液体后行麻醉诱导,诱导后以10 ml·kg 1·h-1的速度维持输液2h,之后以8 ml·kg-1h-1的速度维持至手术结束.输液前后测定患者的肝肾功能、血电解质以及凝血功能,并监测输液前即刻、诱导前即刻、诱导后1、2h和输液结束时即刻各时间点的血乳酸和血糖值.结果 两组患者输注相应液体后,丙氨酸氨基转移酶（alanine aminotransferase,ALT）、天门冬氨酸氨基转移酶（aspartateaminotransferase,AST）、白蛋白（albumin,ALB）、总胆红素（total bilirubin,TBIL）、血尿素氮（blood urea nitrogen,BUN）和血肌酐（serum creatinine,Cr）与输液前比较差异无统计学意义,组间比较差异无统计学意义.电解质方面,输液后2组Na＋、K＋、Cl-、Ca2＋的浓度差异无统计学意义,但实验组输液后Mg2浓度较对照组高[（0.48±0.21） mmol/L vs（0.71±0.31） mmol/L（P＜0.05）].手术过程中2组患者血糖均逐渐上升,术后又下降至输液前水平.两种液体输注后,凝血酶原时间（prothrombin time,PT）和部分凝血活酶时间（activated partial thromboplastin time,APTT）无显著变化.结论 在术中输注SPMCG,对患者肝肾功能、血电解质、血糖、血乳酸及凝血功能无明显不良影响,并且相对于乳酸钠林格注射液,SPMCG能更好地维持血镁水平.     

自制复方电解质果糖溶液在肾移植后多尿期补液治疗中的应用

目的评价自制复方电解质果糖溶液在肾移植后多尿期的补液效果。方法126例肾移植患者随机分为研究组和对照组,每组63例,研究组术后多尿期输注自制复方电解质果糖溶液,对照组多尿期采用循环补液方案输液。监测血电解质、血糖、尿糖及肾功能的变化,对比两组患者补液治疗的效果。结果两组患者补液期间(术后1～21 h)血电解质、酸碱水平均在正常范围,二者间的差异无统计学意义,两组血肌酐相比,差异也无统计学意义;研究组患者的血糖和尿糖的水平以及波动幅度均显著小于对照组,差异有统计学意义(P<0.05)。结论复方电解质果糖溶液可理想地维持肾移植后多尿期的水、电解质及酸碱平衡,并能有效解决传统循环补液治疗时存在的液体种类多、操作繁琐和高血糖等问题。     

复方乳酸钠山梨醇注射液在大面积烧伤患者休克期补液中的应用

目的探讨复方乳酸钠山梨醇注射液(简称复钠醇)在大面积烧伤患者休克期补液中应用的可行性。方法将53例成年大面积烧伤休克期患者(均于伤后6h内入院)随机分为复钠醇组(24例)和葡萄糖组(29例)。复钠醇组在补液中用50g/L复钠醇作为基础水分,葡萄糖组用50g/L葡萄糖作为基础水分。剂量均为2000ml/d.两组患者复苏液中电解质和胶体量按相同公式计算后补给。同时,对葡萄糖组患者额外补充电解质及胰岛素。观察两组患者在纠正休克、能量提供及不良反应等方面的情况,监测肝、肾功能和电解质变化,记录休克期补液量及尿量,同时监测每例患者在入院时和伤后24、48、72h的血糖水平并作比较。结果两组患者在纠正休克、能量提供等方面无明显差别,复钠醇组患者未出现与复钠醇相关的不良反应及肝、肾功能损害,血糖水平均基本正常;在输液过程中,葡萄糖组需额外补充电解质及胰岛素才能维持稳定,而复钠醇组则不需要补充胰岛素或大量的电解质,且利尿效果优于葡萄糖组[复钠醇组伤后第1、2个24h平均尿量为(1.9±0.6)、(3.3±0.8)L,葡萄糖组为(1.0±0.5)、(2.3±0.8)L].结论大面积烧伤患者休克期应用复钠醇,可以有效补充血容量、纠正烧伤休克、利尿并促进水肿消退,同时既能补充电解质,又能提供部分能量,而且不影响血糖水平。     

钠钾镁钙葡萄糖注射液应用于烧伤休克液体复苏的临床疗效评估——前瞻性、随机、单盲、阳性药物对照、多中心临床试验

目的 以乳酸钠林格注射液为对照,验证钠钾镁钙葡萄糖注射液(乐加(R))用于烧伤休克液体复苏方面的有效性和安全性.方法 198例符合入组标准的烧伤患者,伤后6h内开始实施液体复苏治疗,随机数字表法分为试验组和对照组,试验组使用钠钾镁钙葡萄糖注射液,对照组使用乳酸钠林格注射液.用法用量遵循1970年全国烧伤会议公式.液体复苏前测定受试者的血常规、肝肾功能、血生化、凝血功能指标,输液过程中监测血流动力学指标和动脉血气、血糖;在复苏开始后第1个24h、第2个24 h输液结束时同样测定受试者的血液实验室指标.有效性评价指标为受试者在输注上述两种含电解质液体前后的血清电解质、动脉血乳酸含量、血气指标、血糖变化情况,安全性评价指标为临床试验期间观察到的副作用的发生率和发生的具体情况.结果 通过血清电解质维持、血乳酸含量检测、血糖检测、酸碱平衡维持几个方面做出综合评价,两组比较差异无统计学意义.试验组中评为安全的受试者为99例,所占比例为100％.对照组中评为安全和大致安全的受试者为99例,所占比例为100％.两组在安全性分析方面比较差异无统计学意义.结论 在烧伤复苏中输注钠钾镁钙葡萄糖注射液,与目前临床中最常用的乳酸钠林格注射液有相同的安全性和有效性.     

果糖注射液对胸外科术后患者血糖和胰岛素的影响及安全性的临床研究

目的 比较果糖注射液(商品名:丰海能)和葡萄糖注射液对胸外科术后患者血糖和胰岛素的影响及安全性.方法 前瞻性单盲随机对照研究.选取胸外科临床有效病例60例,于手术当天至术后第6天静脉滴注10%果糖注射液(试验组)或10%葡萄糖注射液(对照组),750ml/d,3h内输注完,连用7d.观察患者用药前和用药中血糖和胰岛素水平的变化情况,比较两组之间的差别.同时观察用药前后血尿酸、尿素氮、肝肾功能、心电图等变化以及不良反应的发生情况.结果 试验组输液前后血糖变化值为(0.64±1.98)mmol/L,对照组输液前后血糖变化值为(4.13±1.63)mmol/L,对应试验组比较差异有统计学意义(P＜0.05).试验组用药中对血胰岛素影响亦较小(0.82±9.76)mmol/L,对照组该指标明显升高(8.35±8.55)mmol/L,组间比较差异有统计学意义(P＜0.05).用药后两组患者均未发现血尿酸、尿素升高,肝肾功能和心电图等指标无明显异常变化,未出现不良反应.结论 适量静脉输注果糖注射液对胸外科术后患者血糖和胰岛素的影响较小,有较好的安全性.     

��Ʋ���Һ�����������빲ʶ

液体治疗目的包括复苏、维持液体及电解质平衡,纠正液体失衡和异常分布。生理盐水是最早使用的晶体液,但其并不完全符合生理,又陆续产生了林格液、乳酸林格液和醋酸林格液等。在重症脓毒症病人复苏时推荐使用白蛋白溶液。在失血性休克复苏中,全血仍是最好的选择。液体治疗须对病人进行全面评估,包括病史、体检情况、目前用药情况、临床监测和实验室检查,由此决定病人液体和电解质需要量。复苏后再评估可确保后续液体治疗正确合理。对持续接受静脉液体治疗的病人须定期监测液体需要量、实验室指标、出入量和体重。     

外科病人液体治疗争论与共识

液体治疗目的包括复苏、维持液体及电解质平衡,纠正液体失衡和异常分布。生理盐水是最早使用的晶体液,但其并不完全符合生理,又陆续产生了林格液、乳酸林格液和醋酸林格液等。在重症脓毒症病人复苏时推荐使用白蛋白溶液。在失血性休克复苏中,全血仍是最好的选择。液体治疗须对病人进行全面评估,包括病史、体检情况、目前用药情况、临床监测和实验室检查,由此决定病人液体和电解质需要量。复苏后再评估可确保后续液体治疗正确合理。对持续接受静脉液体治疗的病人须定期监测液体需要量、实验室指标、出入量和体重。     

Effects of a Carbohydrate-Electrolyte Drink on Specific Soccer Tests and Performance

The aim of this study was to examine the effects of a carbohydrate-electrolyte drink on specific soccer tests and performance. Twenty-two professional male soccer players volunteered to participate in the study. The players were allocated to two assigned trials ingesting carbohydrate-electrolyte drink (7% carbohydrates, sodium 24 mmol.l-1, chloride 12 mmol.l-1, potassium 3 mmol.l-1) or placebo during a 90 min on-field soccer match. The trials were matched for subjects’ age, weight, height and maximal oxygen uptake. Immediately after the match, players completed four soccer-specific skill tests. Blood glucose concentration [mean (SD)] was higher at the end of the match-play in the carbohydrate-electrolyte trial than in the placebo trial (4.4 (0.3) vs. 4.0 (0.3) mmol.l-1, P < 0.05). Subjects in the carbohydrate-electrolyte trial finished the specific dribble test faster in comparison with subjects in the placebo trial (12.9 (0.4) vs. 13.6 (0.5) s, P < 0.05). Ratings of the precision test were higher in the carbohydrate-electrolyte trial as compared to the placebo trial (17.2 (4.8) vs. 15.1 (5.2), P < 0.05) but there were no differences in coordination test and power test results between trials. The main finding of the present study indicates that supplementation with carbohydrate-electrolyte solution improved soccer-specific skill performance and recovery after an on-field soccer match compared with ingestion of placebo. This suggests that soccer players should consume carbohydrate-electrolyte fluid throughout a game to help prevent deterioration in specific skill performance.Key Words: Fluid ingestion, soccer match, blood glucose     

���ٿ����������ָ���µ�Χ������Һ������

??Enhanced recovery after surgery in perioperative fluid management YU Wen-kui??LI Ning. Nanjing General Hospital of Nanjing Military Command of PLA??Nanjing 210002??China
Corresponding author??LI Ning??E-mail??liningnju@163.com
Abstract Enhanced recovery after surgery (ERAS) is a new concept of surgical treatment in the 21st century??which recently??has been widely applied and gained good effect. ERAS is defined as a series of optimized perioperative management to reduce the stress of patients??decrease the incidence of complications and mortality??and achieve rapid recovery. Perioperative fluid management is a important component of ERAS??which is throughout the perioperative period??with a great impact on patients’ outcome. In preoperative time??patients should avoid dehydration??shorten the time of fasting and orally administrate carbohydrate. During operation??when maintaining circulating volume??avoiding edema should also be noticed. The amount of fluid infusion should be based on the loss of fluid and the hemodynamic indexes monitored. In postoperative time??patients should be encouraged early orally feeding and stopping intravenous infusion as soon as possible??preventing disturbance of water and electrolyte and tightly controlling the level of serum glucose.     

限制性液体治疗对胆道手术后并发症的影响

目的 探讨限制性液体治疗对胆道手术后并发症的影响.方法 前瞻性分析2006年10月至2008年3月南京军区南京总医院收治的168例接受胆道手术患者的临床资料.所有患者于术前按照封闭信封法随机分成研究组(采用限制性液体治疗,85例)和对照组(采用常规液体治疗,83例).观察两组患者补液量的差异,比较两组患者术后全身并发症发生率、腹部并发症发生率、总体并发症发生率、肠道功能恢复时间、住院时间、病死率的差异.采用x2检验、t检验及Fisher确切概率法对数据进行分析.结果 研究组和对照组术中静脉补液总量的中位值分别为1450 ml和2420 ml,两组比较,差异有统计学意义(t=-5.067,P<0.05).研究组静脉晶体补充量的中位值为850 ml,显著少于对照组的1500 ml(t=-15.190,P<0.05).研究组术后全身并发症发生率和总体并发症发生率分别为9%(8/85)和19%(16/85),低于对照组的22%(18/83)和30%(25/83).两组患者全身并发症发生率比较,差异有统计学意义(x2=4.837,P<0.05).研究组肠道功能恢复时间和住院时间分别为2 d和9 d,显著短于对照组的4 d和12 d(t=-8.102,-2.003,P<0.05).研究组和对照组病死率分别为2%(2/85)和4%(3/83),两组比较,差异无统计学意义(P>0.05).结论 限制性液体治疗降低了胆道手术后并发症的发生率,缩短住院时间,促进患者的术后恢复.

Abstract：

Objective To investigate the effects of intravenous fluid restriction on complications after biliary surgery.Methods The clinical data of 168 patients who received biliary surgery at the Nanjing General Hospital of Nanjing Military Command from October 2006 to March 2008 were prospectively analyzed.All patients were randomly divided into test group(85 patients received fluid restriction treatment)and control group(83 patients received conventional treatment)by the sealed envelope method.The difference in the fluid volume between the 2groups was observed.Differences in systemic complication rate,local complication rate,general complication rate,time to bowl movement,length of hospital stay and mortality between the 2 groups were compared.All data were analyzed using the chi-square test,t test,Fisher exact test,Results The median total volumes of fluid in test group and control group were 1450 ml and 2420 ml,respectively,with significant difference between the 2 groups (t=-5.067,P<0.05).The median volumes of erystalloid solution in the test group was 850 ml,which was significantly lower than 1500 ml of the control group(t=-15.190,P<0.05).The postoperative systemic complication rate and general complication rate of the test group were 9%(8/85)and 19%(16/85),which were lower than 22%(18/83)and 30%(25/83)of the control group.There was a significant difference in the postoperative systemic complication rate between the test group and the control group(x2=4.837,P<0.05).The time to bowl movement and length of hospital stay were 2 days and 9 days in the restriction fluid group,which were significantly shorter than4 days and 12 days in the control group(t=-8.102,-2.003,P<0.05).The mortalities of test group and control group were 2%(2/85)and 4%(3/83),respectively,with no significant difference between the 2 groups(P>0.05).Conclusion Fluid restriction reduces the complication rate,shortens the length of hospital stay and accelerates recovery after biliary operation.     

Impaired oxygenation and increased hemolysis after cardiopulmonary bypass in patients with glucose-6-phosphate dehydrogenase deficiency

BACKGROUND: The purpose of this study was to determine whether the damaging effects of cardiopulmonary bypass, ischemia, and reperfusion would be more pronounced in patients with glucose-6-phosphate dehydrogenase deficiency undergoing cardiac surgery. METHODS: Forty-two patients with glucose-6-phosphate dehydrogenase deficiency underwent open heart procedures using cardiopulmonary bypass. This group was matched with a control group of identical size for comparison of operative course and postoperative outcome. The perioperative variables were compared between the two groups using univariate and multivariate analysis. RESULTS: The duration of ventilation after the operation was significantly longer in the glucose-6-phosphate dehydrogenase-deficient group (13.7 +/- 7.6 hours versus 7.7 +/- 2.8 hours; p < 0.0001). Minimal value of arterial oxygen tension was lower in patients with glucose-6-phosphate dehydrogenase deficiency (66 +/- 12 mm Hg versus 85 +/- 14 mm Hg; p < 0.0001), and more cases of hypoxia (arterial oxygen tension < 60 mm Hg) were found in this group (11 versus 1; p = 0.001). Compared with the control group, patients with glucose-6-phosphate dehydrogenase deficiency had significantly elevated hemolytic indices expressed by bilirubin levels (26 +/- 10 mmol/L versus 17 +/- 6.7 mmol/L; p < 0.0001) and lactic dehydrogenase levels (970 +/- 496 U/L versus 505 +/- 195 U/L; p < 0.0001). They also required significantly more blood transfusion perioperatively (1.9 +/- 1.4 packed cell units/patient versus 0.8 +/- 1.0 packed cell units/patient; p = 0.0001). CONCLUSIONS: Patients with glucose-6-phosphate dehydrogenase deficiency who are undergoing cardiac surgery may have a more complicated course with a longer ventilation time, more hypoxia, increased hemolysis, and a need for more blood transfusion. Because this difference may be caused by subnormal free radical deactivation, strategies that minimize bypass in general and free radicals specifically may be beneficial.     

Evidence for suppression of hepatic glucose-6-phosphatase with carbohydrate feeding

The mechanism by which exogenous glucose stimulates the incorporation of hepatic glucose-6-phosphate into glycogen in fasted rats has not been clearly delineated. We gave glucose intragastrically over a 3.5-h period during which liver glycogen was deposited at linear rates. Simultaneous primed continuous infusion of [2-3H] or [3-3H]glucose established that under these conditions absolute carbon flow through hepatic glucose-6-phosphatase was greatly suppressed. After 1 h, hepatic [UDP-glucose] and [glucose-6-phosphate] had fallen by 50-60% and the former remained low throughout the experiment. By contrast, [glucose-6-phosphate] rebounded to its initial value by 2 h and remained at this level during the subsequent hour. We interpret the data as follows. Exogenous glucose, in addition to acting as a precursor of liver glucose-6-phosphate, causes diversion of the latter away from free glucose formation and into glycogen synthesis. The fall in [UDP-glucose] is in accord with a glucose-induced activation of glycogen synthase, as proposed by Hers (Annu. Rev. Biochem. 1976; 45:167-89.). However, the fall-rise sequence of glucose-6-phosphate concentration constitutes the first direct evidence in vivo for simultaneous inhibition at the level of glucose-6-phosphatase.