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2020 年第 9 期 第 15 卷

醋酸钠林格液对脓毒症休克患者乳酸清除率和组织灌注及电解质水平的影响

Effect of sodium acetate Ringer solution on lactate clearance rate, tissue perfusion and electrolyte balance level in patients with septic shock

作者:邓小彦冼丽娜林志星郑燕玲

英文作者:Deng Xiaoyan Xian Lina Lin Zhixing Zheng Yanling

单位:海南医学院第一附属医院重症医学科,海口570102 

英文单位:Intensive Care Unit the First Affiliated Hospital of Hainan Medical College Haikou 570102 China

关键词:脓毒症休克;醋酸钠林格液;乳酸清除率;组织灌注;电解质平衡

英文关键词:Septicshock;SodiumacetateRingersolution;Lactateclearancerate;Tissueperfusion;Electrolytebalance

  • 摘要:
  • 目的 探讨醋酸钠林格液(AR)、乳酸钠林格液(LR)、95%氯化钠注射液(NS)、复方氯化钠注射液(RS)对脓毒症休克患者乳酸清除率、组织灌注、电解质水平的影响。方法 前瞻性选取20181月至20199月在海南医学院第一附属医院重症医学科住院的脓毒症休克患者83例,完全随机分为4组,给予不同种类的液体复苏:LR组(21例)、NS组(20例)、RS组(20例)、AR组(22例)。分别于液体复苏前(0 h)以及复苏6122448 h时测定血乳酸含量、乳酸清除率、中心静脉压(CVP)、平均动脉压(MAP)、中心静脉血氧饱和度(ScVO2)以及血K+、Na+、Cl-Mg2+浓度。结果 液体复苏6122448 h时,AR组血乳酸含量明显低于LR组、NS组、RS组,乳酸清除率明显高于LR组、NS组、RS组[(15.7±3.3%比(3.0±2.1%、(10.3±3.4%、(8.2±2.9%,(21.5±6.2%比(8.7±3.2%、(14.8±3.6%、(13.3±3.8%,(31.0±7.1%比(8.8±3.3%、(19.5±5.9%、(21.3±6.9%,(44.2±8.6%比(9.4±3.0%、(22.4±5.7%、(21.0±5.4%](均P0.05)。4组液体复苏前后各时点CVPMAPScVO2变化基本一致,组间比较差异均无统计学意义(均P0.05)。液体复苏61224 h时,AR组血Cl-浓度明显低于NS组和RS组[(108±9mmol/L比(118±10)、(118±10mmol/L,(106±9mmol/L比(115±11)、(116±13mmol/L,(106±9mmol/L比(115±11)、(115±11mmol/L],差异均有统计学意义(均P0.05)。结论 LRNSRSAR在改善脓毒症休克患者组织灌注方面基本一致,但是与LR相比,AR可以明显提高乳酸清除率,同时与NSRS相比,AR并不会增加血Cl-水平。

  • Objective To investigate the effects of sodium acetate Ringer solution(AR), lactated Ringer solutionLR, 95% sodium chloride solutionNS and compound sodium chloride injectionRS on lactate clearance rate, tissue perfusion and electrolyte balance levle in patients with septic shock. Methods A total of 83 patients with septic shock admitted to the First Affiliated Hospital of Hainan Medical College from January 2018 to September 2019 were randomly assigned to have liquid resuscitation with different kinds of crystal liquids: LR group(n21), NS group(n20), RS group(n20) and AR group(n22). Serum lactate content, lactate clearance rate, central venous pressure(CVP), mean artery pressure(MAP), systemic central venous oxygen saturation(ScVO2) and serum K, Na, Cl-, Mg2 levels were detected after 0, 6, 12, 24, 48 h of fluid resuscitation. Results At 6, 12, 24, 48h after fluid resuscitation, AR group showed lower serum lactate content and higher lactate clearance rate than LR, NS and RS groupslactate clearance rate: 15.7±3.3% vs 3.0±2.1%,10.3±3.4%,8.2±2.9%; 21.5±6.2% vs 8.7±3.2%,(14.8±3.6%,13.3±3.8%; 31.0±7.1% vs 8.8±3.3%,19.5±5.9%,21.3±6.9%; 44.2±8.6% vs 9.4±3.0%,22.4±5.7%,21.0±5.4%](all P0.05. There were no statistical differences in CVP, MAP and ScVO2 among the 4 groups(all P0.05). At 6, 12, 24 h after fluid resuscitation, serum Cl- levels in AR group were significantly lower than those in NS and RS groups[(108±9mmol/L vs 118±10,118±10mmol/L; 106±9mmol/L vs 115±11,116±13mmol/L; 106±9mmol/L vs 115±11,115±11mmol/L](all P0.05. Conclusions LR, NS, RS and AR are basically same in improving tissue perfusion of septic shock patients. AR can obviously improve lactate clearance rateand it dose not increase serum Cl-.

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