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目的观察经皮肾镜激光碎石术(PCNL)患者围手术期电解质和血糖的变化,探讨术中补充钾、钙、镁、葡萄糖的必要性。方法选择行PCNL患者60例,随机分成A、B两组,每组各30例,术前适当扩容,术中A组以羟乙基淀粉注射液维持静滴,B组以500mL钠、钾、钙、镁、葡萄糖注射液中加入氯化钾1.2g,葡萄糖15g,维持静滴,在两组患者改俯卧位后,以0.9%氯化钠液灌洗前(T0)、灌洗液冲洗35分钟(T35)、冲洗70分钟(T70),分别采静脉血,测得并记录钾、钠、氯、钙、镁和血糖值。结果 A组患者T35与T0相比钠、氯值升高,差异有显著性(P<0.05),钾、镁、钙、血糖值降低,差异有显著性(P<0.05),T70与T0、T35相比钠、氯值升高,差异有显著性(P<0.05),钾、镁、钙、血糖值降低,差异有显著性(P<0.05);B组患者T35与T0相比钠、氯值升高,差异有显著性(P<0.05),钾、镁、钙、血糖值无明显变化,差异无显著性(P>0.05),T70与T0、T35相比钠、氯值明显升高,差异有显著性(P<0.05),钾、镁、钙、血糖值无明变化,差异无显著性(P>0.05);A组与B组比较,钠、氯值无明显差异,差异无显著性(P>0.05),T0钾、镁、钙、血糖值无明显变化,差异无显著性(P>0.05),T70、T35钾、镁、钙、血糖值B组明显高于A组,差异有显著性(P<0.05)。结论行PCNL患者随麻醉及手术时间的延长、冲洗液用量的增多,血钠、氯逐渐升高,血钾、镁、钙、血糖值逐渐降低,患者宜常规监测离子及血糖,术中宜适当补充钾、镁、钙、血糖,以确保患者的安全。
Objective To observe perioperative electrolyte and blood glucose changes in percutaneous nephrolithotomy (PCNL) patients and explore the necessity of intraoperative potassium, calcium, magnesium and glucose replacement. Methods Sixty patients with PCNL were randomly divided into A and B groups, with 30 cases in each group. The volume of PCNL was dilated preoperatively. In group A, intravenous injection of hydroxyethyl starch was used for intravenous infusion. In group B, After adding potassium chloride (1.2g) and glucose (15g) into the calcium, magnesium and glucose injection, the patients were maintained in an intravenous drip. After the patients in the two groups were changed into prone position, the patients were washed with 0.9% sodium chloride solution Minutes (T35), rinsing for 70 minutes (T70), respectively venous blood was collected, measured and recorded potassium, sodium, chloride, calcium, magnesium and blood glucose values. Results Compared with T0, T35 and T0 in group A increased, the difference was significant (P <0.05), and the levels of potassium, magnesium, calcium and blood glucose were decreased, the difference was significant (P <0.05) (P <0.05), while the levels of potassium, magnesium, calcium and blood glucose decreased significantly (P <0.05). Compared with T0, the levels of sodium, (P <0.05), no significant changes of potassium, magnesium, calcium and blood glucose, the difference was not significant (P> 0.05). Compared with T0 and T35, T70 had significantly increased sodium and chloride (P <0.05), no obvious changes of potassium, magnesium, calcium and blood glucose, the difference was not significant (P> 0.05); There was no significant difference between group A and group B (P> 0.05). The levels of potassium, magnesium, calcium and blood glucose in T0 showed no significant difference (P> 0.05), and the levels of potassium, magnesium, calcium and blood glucose in T70 and T35 were significantly higher than those in group A , The difference was significant (P <0.05). Conclusion PCNL patients with anesthesia and surgery time, the amount of flushing fluid increased, serum sodium, chloride gradually increased serum potassium, magnesium, calcium and blood glucose levels gradually decreased, patients should routine monitoring of plasma and blood glucose, surgery should be appropriate Add potassium, magnesium, calcium, blood glucose, to ensure patient safety.