CAJ | 학술논문

目的：探讨复方电解质注射液作为体外循环(cardiopulmonary bypass，CPB)预充液在肝功能不良患者心脏手术中的作用。方法回顾我院2003年7月-2013年12月，因术前合并肝功能异常接受体外循环下心脏手术的患者41例，体外循环晶体预充液2009年10月前使用乳酸林格液，之后使复方电解质注射液。分为乳酸林格液组(A组)18例，复方电解质注射液组(B组)23例，检测两组术前(T1)、转流30 min (T2)、停机后/术后即刻(T3)、术后4 h (T4)、术后24 h (T5)的剩余碱(base excess，BE)、血乳酸(lactic acid，Lac)、电介质水平，术前、术后4 h、术后第1天、第3天、第7天肝功能酶的化变。结果两组天冬氨酸转氨酶(aspartate transaminase，AST)及丙氨酸氨基转移酶(glutamate-pyruvate transaminase，GPT)水平体外循环后进一步升高，B组术后7 d基本恢复到术前水平；Lac浓度、BE负值、氯离子浓度A组均明显高于B组(P＜0.05)， B组中钙离子浓度显著降低，两组血糖在CPB中均升高，组间无统计学差异。结论体外循环中使用复方电解质注射液作为预充液可减少对肝功能的损害，降低血乳酸水平，能快速有效地维持机体酸碱平衡。
목적：탐토복방전해질주사액작위체외순배(cardiopulmonary bypass，CPB)예충액재간공능불량환자심장수술중적작용。방법회고아원2003년7월-2013년12월，인술전합병간공능이상접수체외순배하심장수술적환자41례，체외순배정체예충액2009년10월전사용유산림격액，지후사복방전해질주사액。분위유산림격액조(A조)18례，복방전해질주사액조(B조)23례，검측량조술전(T1)、전류30 min (T2)、정궤후/술후즉각(T3)、술후4 h (T4)、술후24 h (T5)적잉여감(base excess，BE)、혈유산(lactic acid，Lac)、전개질수평，술전、술후4 h、술후제1천、제3천、제7천간공능매적화변。결과량조천동안산전안매(aspartate transaminase，AST)급병안산안기전이매(glutamate-pyruvate transaminase，GPT)수평체외순배후진일보승고，B조술후7 d기본회복도술전수평；Lac농도、BE부치、록리자농도A조균명현고우B조(P＜0.05)， B조중개리자농도현저강저，량조혈당재CPB중균승고，조간무통계학차이。결론체외순배중사용복방전해질주사액작위예충액가감소대간공능적손해，강저혈유산수평，능쾌속유효지유지궤체산감평형。
Objective To explore the effects of multiple electrolytes injection as cardiopulmonary bypass (CPB) priming solution for patients with hepatic dysfunction undergoing open heart surgery.Methods Clinical data about 41 patients with hepatic dysfunction who underwent cardiac surgeries with CPB in our hospital from July 2003 to December 2013were retrospectively analyzed. Lactate Ringer's solution was used as CPB primingfluid before October 2009 and then multiple electrolytes injection were used as priming fluid. They were divided into two groups: lactate ringer's group (group A, n=18) and multiple electrolytes injection group (group B, n=23). BE, Lac and electrolytes levels were detected at pre-CPB (T1), 30 minutes after CPB (T2), off-CPB (T3), postoperative 4 hours (T4) and 24 hours (T5), hepatic enzymes of AST, GPT and blood glucose were measured at preoperation, postoperative 4 hours, days 1, 3, and 7.Results The levels of AST and GPT increased notably after CPB in two groups, but it returned to baseline on postoperative 7 d in group B; the concentrations of Lac, BE, Cl- were significantly higher in group A than those of group B(P<0.05), the plasma calcium level was lower than that of preoperation in group B. There was no difference in blood glucose between two groups.Conclusion Multiple electrolytes injection as CPB priming solution can decrease lactate levels and alleviate the harm to liver caused by CPB, and maintain acid-base balance effectively.