CAJ | 학술논문

目的观察2009年中华医学会麻醉学分会儿科麻醉学组颁布关于小儿围术期液体和输血管理指南前后1年的临床实施情况.方法分析总结2010年在北京协和医院择期行脊柱侧凸手术14岁以下患儿的基本特征、住院天数、术前合并症、手术及麻醉情况、围术期禁饮食期间开具的液体治疗、电解质监测等资料,并与2008年进行比较.结果 235例美国麻醉医师协会(ASA)Ⅰ～Ⅱ级患儿,其中75例术前输注了5％葡萄糖氯化钠；在6岁以下儿童,麻醉医师术中更偏爱5％葡萄糖氯化钠(2008年:15例/2010年:15例),在6～ 14岁患儿,术中更常输注乳酸林格液(2008年:84例/2010年:94例)；没有一例患儿应用低张溶液；82.3％(2008年)、94.3％(2010年)患儿进行了术前电解质检测,27/122例(2008年)、13/113例(2010年)在术后没有检测电解质,并且所有患儿在液体治疗前均未评估血浆电解质水平.术后分别有82.3％(2008年)、70.5％(2010年)患儿只有1次电解质检测；与术前Na+浓度比较,术后第1天Na+浓度平均降低2.0 mmol/L,2010年术后第1天低钠血症的发生率约26.2％,与2008年相比,差异有统计学意义(P=0.044),而高血糖发生率差异无统计学意义(P=0.306).结论小儿围术期液体管理和电解质监测以及相关指南尚需进一步落实与完善.
목적 관찰2009년중화의학회마취학분회인과마취학조반포관우소인위술기액체화수혈관리지남전후1년적림상실시정황.방법 분석총결2010년재북경협화의원택기행척주측철수술14세이하환인적기본특정、주원천수、술전합병증、수술급마취정황、위술기금음식기간개구적액체치료、전해질감측등자료,병여2008년진행비교.결과 235례미국마취의사협회(ASA)Ⅰ～Ⅱ급환인,기중75례술전수주료5％포도당록화납；재6세이하인동,마취의사술중경편애5％포도당록화납(2008년:15례/2010년:15례),재6～ 14세환인,술중경상수주유산림격액(2008년:84례/2010년:94례)；몰유일례환인응용저장용액；82.3％(2008년)、94.3％(2010년)환인진행료술전전해질검측,27/122례(2008년)、13/113례(2010년)재술후몰유검측전해질,병차소유환인재액체치료전균미평고혈장전해질수평.술후분별유82.3％(2008년)、70.5％(2010년)환인지유1차전해질검측；여술전Na+농도비교,술후제1천Na+농도평균강저2.0 mmol/L,2010년술후제1천저납혈증적발생솔약26.2％,여2008년상비,차이유통계학의의(P=0.044),이고혈당발생솔차이무통계학의의(P=0.306).결론 소인위술기액체관리화전해질감측이급상관지남상수진일보락실여완선.
Objective To audite and compare the perioperative practices ot intravenous fluids and electrolyte & glucose monitoring in children undergoing operations for scoliosis in 2008,2010,prior to and after the publication of guideline in 2009.Methods Retrospectivc audit was conducted at Peking Union Medical College Hospital,a tertiary referral teaching hospital in Beijing,China.Children under 14 years old with scoliosis treated surgically in 2008 and 2010 were recruited.The following data were collectcd from medical files:age,gender,weight,duration of hospitalization,concurrent illness,operation,anesthesia,fluid prescribed during perioperative fasting period,electrolyte monitoring and postoperative pain control,etc.Results Among 235 American Society of Anesthesiologists (ASA) Ⅰ - Ⅱ cases,75 children received dextrose 5％ or saline 0.9％ during the preoperative fasting period. Intraoperatively, the anesthesiologists preferred dextrose 5％ or saline 0.9％ in children under 6 years old (n =15,2008; n =15,2010) and Ringer's solution in those aged 6 - 14 years ( n =84,2008 ; n =94,2010) and hypotonic fluid was not used.And 82.3％ and 94.3％ of them received electrolyte examinations preoperatively.The electrolyte results were unavailable postoperatively in 27/122 (in 2008) and 13/113 (in 2010) and serum electrolytes were not assessed before fluid treatment postoperatively.Electrolytes were monitored only once in 82.3 ％ ( in 2008 ) and 70.5％ ( in 2010) patients.Compared with the prcoperative concentration of sodium ion,the mean decrease was approximately 2.0 mmol/L at Day 1 postoperation.Hyponatremia at Day 1postoperation in 2010 was more common than that in 2008 ( 26.2％ vs 23.6％ ; P =0.044 ). But no significant difference existed between the incidence of hyperglycemia of the same day in 2008 and that in 2010 (P- 0.306 ). Conclusion Compared with that in 2008,our recent practice of intravenous fluid prescription and electrolyte monitoring is ill-consistent with the recommendations in 2009.Implementation of optimal perioperative fluid management is warrantcd.