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Objective To observe the effect of acetated Ringer's solution or lactated Ringer's solution on intra-operative vital signs and blood gas analysis indexes in children (aged 1-6 years) undergoing tibia pseudoarthrosis orthopaedic operation. Methods Sixty-four children who underwent tibial pseudoarthrosis orthopaedic operation admitted to the Department of Anesthesiology of Hunan Children's Hospital from October 2016 to October 2018 were enrolled and anesthesia was performed by general anesthesia combined with epidural anesthesia, children were randomly divided into a sodium lactated Ringer's solution injection group (LR group) and a acetated Ringer's solution injection group (AR group), and different groups of children were treated with the corresponding crystal solution for intra-operative maintenance. The vital signs and results of blood gas analysis, etc of the two groups were compared at T1 (before the operation), T2 (2 hours after the beginning of operation) and T3 (at the end of operation). Results Finally, 22 patients in LR group and 28 patients in AR group had completed the study. The arterial partial pressure of carbondioxide (PaCO2), blood Na+, K+, Ca2+, glucose, hematocrit (HCT), bicarbonate (HCO3-), total hemoglobin (THb), etc laboratory indicators as well as vital signs of heart rate, systolic blood pressure, diastolic blood pressure, body temperature, etc. showed no statistically significant differences between the two groups at T1 (all P > 0.05). The lactate (Lac) levels at T2 and T3 in AR group were obviously lower than those in LR group (mmol/L: T2 was 1.01±0.21 vs. 1.42±0.47, T3 was 1.38±0.53 vs.2.07±0.48, both P < 0.05) , while pH, base excess (BE) and HCO3- were obviously higher in AR group [pH: T2 was 7.35±0.08 vs. 7.32±0.07, T3 was 7.33±0.06 vs. 7.28±0.03; BE (mmol/L): T2 was 1.02±0.18 vs. 0.67±0.45, T3 was 0.03±0.28 vs. -0.01±0.57; HCO3- (mmol/L): T2 was 21.28±1.20 vs. 20.10±0.17, T3 was 21.09±0.28 vs. 19.96±6.67, all P < 0.05]. Conclusion In the orthopaedic surgery of children's tibia pseudoarthrosis orthopaedic operation, acetated Ringer's solution not only can maintain water, electrolyte, acid-base balance and blood circulatory stabilities but also can reduce the increase of lactate level, which is conducive to maintaining the stability of the internal environment in the organism.
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Objective To evaluate aggressive hydration with lactated Ringer′s solution for prophylaxis of post-ERCP pancreatitis ( PEP ) during the perioperative period. Methods CNKI, VIP, Wangfang,Pubmed,Embase and Cochrane Library were searched for randomized controlled trials( RCTs) on aggressive hydration with lactated Ringer′s solution for preventing PEP published from the setup time of databases to June 2018. According to the inclusion and exclusion criteria, RCTs were selected by two researchers,data were extracted and methodological quality was assessed independently. Revman 5. 3 was used to perform the meta-analysis.The heterogeneity among the included RCTs was analyzed by using the Q test and the chi-square test. The funnel plots,the risk of bias graph and the risk of bias summary were used to evaluate publication bias. Results A total of 10 RCTs with 1727 patients were included. Meta-analysis showed that 10 RCTs had no significant heterogeneity ( P=0. 10, I2 =39％) , aggressive hydration with lactated Ringer′s solution could reduce the incidence of PEP(OR=0. 37,95％CI:0. 26-0. 53,P<0. 00001). Hyperamylasemia incidence was included in 6 RCTs,and the results showed that aggressive hydration with lactated Ringer′s solution could reduce the incidence of hyperamylasemia ( OR=0. 41, 95％CI:0. 27-0. 64, P<0. 00001 ) . A total of 4 RCTs compared the incidence of abdominal pain after ERCP between the experimental group and the control group. Meta-analysis showed that aggressive hydration with lactated Ringer′s solution could reduce the incidence of abdominal pain ( OR=0. 32, 95％CI: 0. 15-0. 68, P=0. 003) . Conclusion Aggressive hydration with lactated Ringer′s solution can effectively prevent PEP and other complications.
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The efficacy of florfenicol associated or not to intravenous fluid therapy for treatment of Salmonella Dublin-infected calves was determined. Twenty-four healthy 10 to 15-day-old Holstein calves were randomly allotted into four groups, with six animals each: control (group 1); infected with 10(8)CFU Salmonella Dublin and not treated (group 2); infected with 10(8)CFU Salmonella Dublin and treated with florfenicol (group 3); and infected with 10(8)CFU Salmonella Dublin and treated with florfenicol associated to fluid therapy (group 4). All animals were submitted to physical examination just before inoculation and every 24 hours, during seven days after experimental infection. Rectal swabs and blood samples were collected for Salmonella Dublin isolation and pH and blood electrolytes determination. The experimental infection with Salmonella Dublin induced clinical signs of salmonellosis, such as diarrhea and fever, and caused reduction in blood concentrations of pH, sodium, potassium and chlorides. The treated calves showed good clinical recovery, and the group treated with antibiotic in combination to fluid therapy presented a faster and more efficient correction of the hydro-electrolyte balance.
Avaliou-se a eficácia terapêutica do florfenicol associado ou não à fluidoterapia intravenosa no tratamento de bezerros infectados experimentalmente com Salmonella Dublin. Foram utilizados 24 bezerros sadios da raça Holandesa com 10 a 15 dias de idade, distribuídos aleatoriamente em quatro grupos experimentais, constituídos por seis animais cada: controle (grupo 1); infectado com 10(8)UFC de Salmonella Dublin e não tratado (grupo 2); infectado com 10(8)UFC de Salmonella Dublin e tratado com florfenicol (grupo 3); e infectado com 10(8)UFC de Salmonella Dublin (grupo 4) e tratado com florfenicol associado à fluidoterapia. Todos os animais foram submetidos ao exame físico logo antes da inoculação e a cada 24 horas, durante sete dias após a infecção experimental. Foram colhidas amostras de suabes retais para o isolamento de Salmonella Dublin e amostras de sangue para determinação dos valores de pH e dosagem de eletrólitos sanguíneos. A infecção experimental com Salmonella Dublin induziu sinais clínicos de salmonelose, como diarreia e febre, e provocou redução do valor do pH e das concentrações sanguíneas de sódio, potássio e cloreto. Os bezerros submetidos aos tratamentos mostraram boa recuperação clínica, sendo que o grupo tratado com antibiótico combinado à fluidoterapia apresentou correção mais rápida e eficiente do equilíbrio hidroeletrolítico.
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Objective To compare the time course of distribution and elimination of gelatin and lactated Ringer's solution (LR) by volume kinetics and mass balance analysis during hemorrhagic shock in dogs, and try to design and optimize fluid therapy in a more scientific manner. Methods Twenty dogs were randomly divided into 4 groups: CL group, CG group, BL group, and BG group. Each animal was subjected to two randomly ordered experiments that separated for at least 1 week. In the first phase, plasma volume expansion was studied in the state of anesthesia, animals received 30 mL/kg of LR (CL group) or 10 mL/kg of gelatin (CG group) over 30 min. In the second phase, plasma volume expansion was studied in the state of hemorrhagic shock, animals received 30 mL/kg of LR (BL group) or 10 mL/kg of gelatin (BG group) over 30 min. Hb concentration and Hct were measured every 5 min during and after infusion for 90 min. Hemodynamic parameters were recorded at the same time. The distribution and elimination of infused fluid were studied by volume kinetics, based on serial analysis of hemoglobin dilution in arterial blood, and by mass balance that incorporated volume calculations derived from volume kinetic analysis and measurements of urinary volumes. Results When a one-volume kinetic model was fitted to the data, the value of V and Kr in CG, BL, and BG group were significantly smaller than those in CL group (P<0.05), which could be found from the computer-generated curves.When a two-volume kinetic model was fitted to the data, the value of V1, Kr, Kt in BL group were significantly smaller than those in CL group (P<0.05). The calculations based on mass balance corresponded to the predicted based on volume kinetics. The change of central volume (CCV) in BL, BG, and CG group was significantly greater than those in CL group (P<0.05). The VEE in BG and CG group was significantly higher than that in BL and CL group. The value of VEE in BL group was significantly higher than that in CL group (P<0.05). Conclusions Both of the efficacy of lactated Ringer's solution and gelatin increased significantly in the state of hemorrhagic shock, and the former increased more.
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Autologous normovolemic hemodilution (ANH) is one of the methods to conserve blood donor (homologous). The decrease in hemoglobin (Hb) due to bleeding in major surgery will be minimized and the hematocrite (Hct) will be adjusted accordingly by this method. However, due to its impractical clinical application, another simpler hemodilution method is used, i.e. hypervolemic hemodilution (HHD), using 6% dextran 70 and lactated Ringer solutions. The aim of this randomized comparative study was to investigate the impacts of both hemodilution methods (ANH and HHD) on mean arterial pressure (MAP), heart rate (HR), hemoglobin (Hb) and hematocrite (Hct) in anesthetized patients undergoing major surgery. Fourteen (14) women fulfilling the inclusion and exclusion criteria were divided into 2 groups. Seven (7) women received ANH and seven (7) women received HHD method. There were significant statistical differences (P<0.05) between ANH and HHD groups in MAP and Hct after 1 minute (86.3±9.1 vs. 99.1±6.4 on MAP) and (27.3±1.7 vs. 31.5±4.4 on Hct) and after 20 minutes (87.7±7.3 vs. 98.3±6.8 on MAP) and (27.4± 1.7 vs. 3.6±4.8 on Hct) post-hemodilution respectively. There was no difference in HR and Hb. No statistical difference between the four parameters tested after 120 minutes post-hemodilution. It may be concluded that both methods worth to be used in clinical setting although further studies are required.
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Dextranos , Presión Arterial , HemodiluciónRESUMEN
Objective To compare the effects of the two kinds of crystalloid solutions on glycometabolism in type 2 diabetic patients during the operation for the sclestion of the most suitable crystalloid solution. Methods In the forty scheduled gastrointestinal operation patients,there were twenty (D-group) type 2 diabetic patients and the others (N-group) were non-diabetic patients. Each of the two groups were randomly divided into two groups according to infusing different crystalloid solutions: lactated Ringer’s solution (L group), Plasma Lyte A (A group).So the patients were divided into D-L group,D-A group,N-Lgroup,N-A group.The blood glucose concentration,the blood lactate concentration and artery blood gas analysis before operation (T0) and at the end of operation(T1)were measured . Results The blood glucose concentrations had significant increase at the end of operations,and the blood glucose concentrations of D group were higher than that of N group at T0 and T1.The lactate concentrations before operation were normal in all the patients, but the lactate concentrations were over the normal limits after infusing lactated Ringer’s solution and remained normal after infusing Plasma Lyte A.The lactate concentrations had significant increase in the other three groups except N-A group. Conclusion Plasma Lyte A is the more safe and efficient crystalloid solution for diabetic patients during the operation.
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BACKGROUND: Changes in acid-base balance and serum electrolytes by infusion of lactated Ringer's solution in liver cirrhosis patienst during liver surgery are poorly characterized. In this study, we evaluated the effects of infusing large amount of lactated Ringer's solution on acid-base and serum electrolytes during liver surgery in cirrhosis patients. METHODS: Thirty-two patients were divided into two groups. Group I (n = 21) was made up of patients who had received liver lobectomy without cirrhrosis. Group II (n = 11) was made up of patients who had received liver lobectomy with cirrhosis above a moderate level. Arterial blood gas and serum electrolyte levels were checked 4 times during the study in each patient: just after the operation start, after infusing 3,000 ml and 6,000 ml of lactated Ringer's solution during operation, and 30 minutes after arrival at the postanesthesia care unit. RESULTS: pH and base excess decreased according to the amount of lactated Ringer's solution used in both groups and these results were significant. Serum electrolyte levels were not changed and only Ca2+ levels were significantly different in the two groups. The cause of changing of Ca2+ levels found out by intravenous infusion of Ca2+ solution. CONCLUSIONS: In liver surgery patients with or without liver cirrhosis decreased pH and base excess in serum by increased amount of used lactated Ringers solution during liver surgery but in serum electrolytes and others acid-base parameters, CVP, changes on there were not any statistical significant. When a large amount of LR solution is used in liver surgery, we recommend regular arterial blood gas analyses for acid-base balance and an infusing speed of 20 ml/kg/h.