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目的 评价钠钾镁钙葡萄糖注射液用于头颈部缺损游离皮瓣修复手术补液的有效性和安全性.方法 选择2009年1月至2011年12月中国医科大学口腔医学院口腔颌面外科收治的40例口腔颌面部恶性肿瘤晚期患者,均择期行颅颌面联合切除治疗,游离组织瓣修复缺损.随机分为A、B两组,每组20例.两组患者术中分别输入钠钾镁钙葡萄糖注射液和乳酸林格液进行补液.在麻醉诱导前(T1)、血管吻合前(T2)和血管吻合后即刻(T3)抽取桡动脉血检测血气分析[酸碱度(pH值)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、碳酸氢根(HCO3-)、二氧化碳总含量(TCO2)、碱剩余(BE)、动脉血氧饱和度(SaO2)]、电解质(Na+、K+、Ca2+)、血糖和乳酸等指标,并进行各时点组间及组内比较.结果 与T1时点比较,两组患者术中BE均明显降低,PaO2均明显增高(P＜0.05)；血糖浓度和乳酸浓度均明显升高(P＜0.05)；其他血气分析和电解质指标均无明显变化.组间比较,在T3时点B组BE值比A组降低更明显(P＜0.05),A组血糖浓度比B组高(P＜ 0.05)；在T2、T3时点B组乳酸浓度比A组高(P＜0.05).结论 在长时间的大手术中输入大量钠钾镁钙葡萄糖注射液是安全、有效的,且比乳酸林格液对乳酸的影响更低,更具有优势.

The effects of sodium potassium magnesium calcium glucose injection in patients undergoing major head and neck surgery requiring free flap reconstruction

Objective To investigate the effects of sodium potassium magnesium calcium glucose injection in patients undergoing major head and neck surgery requiring free flap reconstruction. Methods Forty patients scheduled for major head and neck surgery requiring free flap reconstruction were randomly divided into sodium potassium magnesium calcium glucose injection group （Group A, n=20） and lactate Ringer＇s solution group （Group B, n=20）. After induction of anesthesia the patients received 8ml/kg/h sodium potassium magnesium calcium glucose injection or lactate Ringer＇ s solution. Arterial blood samples were taken before induction （T1）, before microvascular anastomosis （T2） and after mi- crovascular anastomosis （T3） for arterial blood gas analysis, and test hematocrit, hemoglobin, the concentrations of glucose, lactic acid and plasma electrolytes. Results The hemodynamics indexes showed no different changes. Compared with T1, BE values in all patients decreased during surgeries. At T3, BE value in Group B was lower than that in Group A （P 〈 0.05）. Other arterial blood gas analysis results and the concentrations of plasma electrolytes had no statistical changes all the time. The concentration of glucose in Group A was higher than that in Group B. The concentration of lactic acid in all patients increased significantly. At T3, the concentration of lactic acid in Group B was much higher than that in Group A, P 〈 0.05. Conclusion It is safe and effective to infuse high dose of sodium potassium magnesium calcium glucose injection during major surgeries. Sodium potassium magnesium calcium glucose injection is better than lactate Ringer＇s solution to prevent increasing the concentrations of lactic acid sharply.