【罂粟摘要】腹腔镜手术期间的电解质、白蛋白和酸碱平衡

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腹腔镜手术期间的电解质、白蛋白和酸碱平衡

贵州医科大学  麻醉与心脏电生理课题组

翻译：陈锐   编辑：马艳燕  审校：曹莹

背景：手术引起的炎症会破坏内皮通透性，导致液体和白蛋白穿过血管屏障。用于恢复循环稳态的液体疗法可能会导致液体正平衡，这已被证明会增加手术患者的发病率和死亡率。目前的研究旨在探究一组在全身麻醉下接受腹腔镜手术的患者在循环白蛋白、液体电解质平衡以及酸碱平衡方面的病理生理变化。

方法：单中心前瞻性观察研究。对接受腹腔镜结直肠手术的患者进行筛选。手术前禁食条件一致。在手术前收集血红蛋白、尿液和血浆的数据，然后在预设的时间点收集。在手术前后测量白蛋白/肌酐比值。根据生理学理论模型比较预期和实际循环中钠浓度。研究的主要观察指标包括评估和量化电解质、白蛋白和酸碱平衡的变化。

结果：该研究纳入38名患者。患者电解质呈阳性（钠离子  295 [244-375] mmol，氯离子 234 [195-295] mmol，钾离子 16.8 [12.0-21.4] mmol）和体液平衡（2165 [1727-2728] mL）。液体正平衡与稳定的氯化物（105 [103-107] VS 103 [102-106] mmol/L，P 值差异无统计学意义）和血钾（4.2 [3.8-4.4] VS 4.1 [3.6-4.4] mmol/L，P 值差异无统计学意义）水平有关，但钠浓度随时间降低（138 [137-140] VS 139 [138-141] mmol/L，P <0.05)。手术结束时白蛋白/肌酐比值较高 134 [61-267] VS 7 [4-14]，P<0.001)。(注：以上各数据均为研究结束时的值 VS 基础值) 

    结论：数据显示，在腹腔镜下接受结直肠手术的患者液体正平衡、循环白蛋白减少和白蛋白尿增加。但正钠平衡并不总是完全与血浆钠浓度增加有关。

原始文献来源：Sabbatini G, Caccioppola a, Lusardi AC, Pozzi T, Bianco C, Baio S, et al. ERlectrolytes, albumin and acid base equilibrium during laparoscopic surgery. Minerva Anestesiol 2021;87:1300-8.

Electrolytes, albumin and acid base equilibrium during laparoscopic surgery

Background: Surgery, causing inflammation, disrupts endothelial permeability leading to movement of fluids and albumin across the vascular barrier. Fluid therapy for restoring circulatory homeostasis may lead to positive fluid balance which has been shown to increase morbidity and mortality in surgical patients. The current investigation aims to describe physio-pathological changes in circulating albumin, fluid and electrolyte balance, and acid-base equilibrium in a cohort of patients undergoing laparoscopic surgery under general anesthesia.

Methods: Single-center prospective observational study. Patients undergoing laparoscopic colorectal surgery were screened for eligibility. Before surgery, the baseline fasting conditions were homogenized. Hemoglobin, urinary and plasmatic were collected before surgery and then at pre-defined timepoints. Albumin/creatinine ratio was measured before and after surgery. Expected and actual circulating Sodium concentrations were compared according to a physiological theoretical model. Assessment and quantification of changes in major electrolytes, albumin and acid-base balance was defined as the primary outcome of the study.

Results: Thirty-eight patients were enrolled in the protocol. Patients had a positive electrolytes (Na+ 295 [244-375] mmol, Cl- 234 [195-295] mmol, K+ 16.8 [12.0-21.4] mmol) and fluid balance (2165 [1727-2728] mL). The positive fluid balance was associated with stable chloride (105 [103-107], end study vs. 103 [102-106] mmol/L, baseline, P not significant) and potassium (4.2 [3.8-4.4], end study vs. 4.1 [3.6-4.4] mmol/L, baseline, P not significant) levels, but sodium concentrations decreased over time (138 [137-140], end study vs. 139 [138-141] mmol/L, baseline, P<0.05). The albumin/creatinine ratio was higher at the end of surgery 134 [61-267] vs. 7 [4-14], P<0.001). 

Conclusions: Data from patients undergoing colorectal laparoscopic surgery showed a positive fluid balance, decreased circulating albumin and increased albuminuria. A positive sodium balance was not always associated with an increase in sodium plasma concentration.