摘要
目的探讨老年全髋关节置换术(total hip arthroplasty, THA)后使用碳酸氢钠对患者血清乳酸(lactic acid,Lac)水平、血流动力学及炎性指标的影响。方法回顾性分析2018年2~11月在本院行单侧THA的90例老年患者的病例资料,根据术后是否静脉滴注碳酸氢钠分为碳酸氢钠组和对照组(n=45)。碳酸氢钠组术后给予静脉滴注5%碳酸氢钠2 mL/kg 1次,而对照组未给予上述处理。记录给药前(T0)、给药后12 h(T1)、给药后24 h (T2)、给药后48 h(T3)各时间点的血气分析、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)指标及术前和术后血常规、C反应蛋白(CRP)、红细胞沉降率(erythrocyte sedimentation rate, ESR)炎性指标;评估术前及术后3个月的疼痛视觉模拟评分(visual analogue score, VAS)和Harris评分。结果两组患者的一般资料无统计学差异。碳酸氢钠组与对照组的MAP在T0时差异无统计学意义,在T2、T3时碳酸氢钠组较对照组明显降低(P<0.05);碳酸氢钠组与对照组的乳酸值在T0时无明显差异,在T2、T3时碳酸氢钠组较对照组明显降低(P<0.05);碳酸氢钠组与对照组的pH值在T0、T1、T3时差异无统计学意义,在T2时碳酸氢钠组较对照组明显升高(P<0.05);两组患者炎性指标在术前差异无统计学意义,术后均较术前显著升高(P<0.05),但碳酸氢钠组显著低于对照组(P<0.05);两组患者在术后3个月的Harris评分均较术前显著上升(P<0.05),VAS评分均较术前显著下降(P<0.05),但组间比较均无统计学差异。结论老年患者全髋置换术后输注少量碳酸氢钠可显著降低术后48 h的血乳酸水平;维持术后血流动力学稳定有助于降低术后炎症反应及其他并发症的发生。
Objective To observe the effect of sodium bicarbonate on serum lactic acid(Lac)level,blood pressure and inflammatory indexes in elderly patients after total hip replacement.Methods We retrospectively analyzed the clinical data of 90 elderly patients undergoing unilateral total hip arthroplasty(THA)in our hospital between February,2018 and November,2018.Among these patients,45 received intravenous infusion of 5%sodium bicarbonate(2 mL/kg)immediately after the operation,while the other 45 patients did not receive the treatment(control group).Blood gas analysis was performed and the heart rate(HR)and mean arterial pressure(MAP)were measured before(T0)and at 12(T1),24(T2)and 48 h(T3)after sodium bicarbonate administration.Blood routines,C-reactive protein(CRP)level,and erythrocyte sedimentation rate(ESR)before and after the operation were assessed,and visual analogue scale(VAS)scores and Harris scores before and at 3 months after the operation were evaluated for each patient.Results The general baseline data were comparable between the 2 groups.The MAP and the level of lactic acid did not differ significantly between the 2 groups at T0,but were significantly lower in sodium bicarbonate group at T2 and T3(P<0.05).The pH value did not differ significantly between the 2 groups at T0,T1 and T3,but was significantly higher in sodium bicarbonate group at T2(P<0.05).The inflammatory parameters,which were comparable between the 2 groups before the operation,increased significantly after the surgery in both groups(P<0.05),but were significantly lower in sodium bicarbonate group than in the control group(P<0.05).In both groups,the Harris scores were increased(P<0.05)and the VAS scores were decreased significantly at 3 months after the operation without significant difference between the 2 groups(P<0.05).Conclusion Infusion of small-dose sodium bicarbonate can significantly reduce blood lactic acid level at 48 h after total hip replacement and helps to maintain postoperative hemodynamic stability,reduce postoperative inflammati
作者
梁帅楠
孙茂淋
郑小龙
何锐
陈光兴
杨柳
LIANG Shuainan;SUN Maolin;ZHENG Xiaolong;HE Rui;CHEN Guangxing;YANG Liu(Center for Joint Surgery,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038;Troop 95979,Tai'an,Shandong Province,271000,China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2020年第22期2231-2237,共7页
Journal of Third Military Medical University
基金
国家重点研发计划项目(2017YFC110705)
广东省重点研发项目(2018B090906003)。
关键词
人工全髋关节置换术
碳酸氢钠
乳酸
老年人
血压
炎性指标
artificial total hip replacement
sodium bicarbonate
lactic acid
aged
blood pressure
inflammatory index
