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| 复方碳酸氢钠用于新生儿坏死性小肠结肠炎术中液体治疗的效果 |
| Effect of compound bicarbonated on intraoperative fluid therapy in neonatal necrotizing enterocolitis |
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| DOI：10.12089/jca.2022.02.014 |
| 中文关键词: 复方碳酸氢钠 新生儿坏死性小肠结肠炎 患儿 代谢酸中毒 液体治疗 |
| 英文关键词: Compound bicarbonated Neonatal necrotizing enterocolitis Children Metabolic acidosis Fluid therapy |
| 基金项目:江西省卫生健康委科技计划（202130912） |
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| 中文摘要: |
目的 探讨复方碳酸氢钠用于新生儿坏死性小肠结肠炎术中液体治疗的效果。
方法 选择2020年3月至2021年5月拟行开腹探查术的新生儿坏死性小肠结肠炎患儿60例，男37例，女23例，日龄<28 d，出生胎龄29～35周，体重1～3 kg，ASA Ⅱ或Ⅲ级。采用随机数字表法将患儿分为三组：复方碳酸氢钠组（B组）、复方醋酸钠组（A组）和复方乳酸钠组（L组），每组20例。患儿均采用气管插管全麻联合骶管阻滞。B组、A组和L组分别先予以复方碳酸氢钠、复方醋酸钠和复方乳酸钠20～25 ml·kg-1·h-1静脉泵注，1 h后调节为10～15 ml·kg-1·h-1静脉泵注直至术毕。记录输液开始即刻、输液开始后1 h和输液结束即刻的动脉血pH值、PaO2、PaCO2、BE值、HCO3-、Na+、K+、Ca2+、血糖（Glu）和血乳酸（Lac）浓度。记录上述时点的HR、MAP、SpO2。记录输液开始即刻至输液开始后1 h和输液开始后1 h至输液结束即刻两个时段的输液量、尿量和出血量。记录术中葡萄糖、多巴胺使用量和输血量，记录术中低血压、少尿和代谢性碱中毒发生情况。
结果 输液开始后1 h和输液结束即刻A组和L组动脉血pH值、BE值、HCO3-浓度均明显低于B组（P<0.05）。输液开始后1 h和输液结束即刻A组和B组动脉血Lac明显低于L组（P<0.05）。B组有1例（5%）使用葡萄糖，A组和L组均无一例使用葡萄糖。A组和L组分别有2例（10%）和1例（5%）输血，B组无一例输血。三组术中低血压发生率差异无统计学意义，三组无一例发生少尿和代谢性碱中毒。
结论 与复方乳酸钠和复方醋酸钠比较，复方碳酸氢钠可更加快速有效地纠正新生儿坏死性小肠结肠炎手术患儿的代谢性酸中毒，维持酸碱平衡，可安全用于术前已存在代谢性酸中毒的新生儿坏死性小肠结肠炎患儿的术中液体治疗，且有一定优势。 |
| 英文摘要: |
Objective To study the effect of compound bicarbonated on intraoperative fluid therapy in neonatal necrotizing enterocolitis.
Methods Sixty children with neonatal necrotizing enterocolitis from March 2020 to May 2021 undergoing laparotomy, 37 males and 23 females, aged less than 28 days, gestational age 29-35 weeks, weighing 1-3 kg, ASA physical status Ⅱ or Ⅲ, were randomly divided into three groups using random number table method: compound bicarbonated group (group B), compound acetate group (group A) and compound lactate (group L), 20 children in each group. All children were given general anesthesia with tracheal intubation and sacral block. Group B was given 20-25 ml·kg-1·h-1 compound bicarbonated intravenously, and adjusted to 10-15 ml·kg-1·h-1 after 1 hour until the operation was completed. Group A and group L received compound acetate and compound lactate according to the same usage and dosage as group B. Puncture and catheterize any of the bilateral radial arteries, brachial arteries and femoral arteries. The arterial blood pH value, PaO2, PaCO2, BE value, concentration of HCO3-, Na+, K+, Ca2+, and arterial blood glucose (Glu) and arterial blood lactic acid (Lac) were recorded at the beginning of infusion, 1 hour after infusion and the end of infusion. HR, MAP, and SpO2 were recorded from the beginning of infusion, 1 hour after infusion and the end of infusion. The volume of infusion, urine output and bleeding were observed and recorded from the beginning of infusion to 1 hour after infusion, and from 1 hour after infusion to the end of infusion. Observe and record the use of glucose and dopamine and blood transfusion in the three groups of children during the operation. The occurrence of intraoperative hypotension, oliguria and metabolic alkalosis were observed.
Results Compared with group B, the arterial blood pH value, BE value, concentration of HCO3- in groups A and L were significantly decreased from 1 hour after infusion to the end of infusion (P < 0.05). Compared with group L, the arterial blood Lac in groups A and B were significantly decreased from 1 hour after infusion to the end of infusion (P < 0.05). There was 1 children in group B using glucose, and no children using glucose in groups A and L. There were 2 blood transfusions in group A and 1 blood transfusion in group L, and no blood transfusion in group B. There were no significantly differences in the incidence of intraoperative hypotension among the three groups. There was no children of oliguria and metabolic alkalosis in the three groups.
Conclusion Compared with compound lactate and compound acetate, compound bicarbonated can more quickly and effectively correct metabolic acidosis and maintain acid-base balance in patients with neonatal necrotizing enterocolitis undergoing laparotomy. It can be safely used for intraoperative fluid therapy of neonatal necrotizing enterocolitis in children with metabolic acidosis before surgery, and has certain advantages． |
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