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斯图尔特的理论和酸变化诱导的晶体注在人类:一个随机生理试验
Antonio Maria Dell'Anna1, Domenico Luca Grieco2, Cristina Dominedò1
1Department of Anesthesia and Intensive Care Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, L.Go F. Vito, 00168, Rome, Italy.
Annals of intensive care
|April 22, 2025
概括
高化物晶体化物像正常盐水一样,通过减少强离子差异来降低血pH值,导致酸性. 由于含有较低的化物,乳酸林格和水晶醇更好地保持pH值.
科学领域:
- 麻醉学 麻醉学
- 密集护理医学 密集护理医学
- 脏生理学 脏生理学
背景情况:
- 斯图尔特的酸理论解释了通过强离子差异和弱酸度来解释水晶体输注的pH值变化.
- 之前对人体进行的评估脏反应和在晶类药物输注期间血液稀释效应的研究是有限的.
- 这项研究评估了斯图尔特在接受晶体注的人类中的酸方法.
研究的目的:
- 研究不同晶体溶液对手术患者血pH的影响.
- 为了评估斯图尔特的酸理论在晶体输液的背景下的有效性.
- 为了比较正常盐水,乳酸Ringer's和Crystalsol对酸平衡和电解质的影响.
主要方法:
- 一项随机试验,涉及45名手术患者,血液损失最小.
- 患者接受了10毫升/千克的正常盐水,乳酸林格或Crystalsol,然后在2小时后得到20毫升/千克.
- 血和尿液酸参数和电解质被测量,以pH值为第二次玻尿酸注射后一小时的主要终点.
主要成果:
- 正常的盐水给药导致pH值显著降低 (7.34),与乳酸林格 (7.40) 和Crystalsol (7.42) 相比,第二次液体玻尿酸注射后一个小时.
- 盐水组接受了更多的化物,并且随着时间的推移,血中化物度的增加更大.
- 虽然尿液中化物排泄的总体情况相似,但盐水组在实验结束时显示尿液中化物度较高,尿液尿率较低.
结论:
- 具有高化物含量的晶体溶液,如正常盐水,降低血pH值,符合斯图尔特的方法.
- 观察到的pH值下降归因于强离子差异的减少和渐进的血稀释性酸性疾病.
- 对高化物负荷的反应似乎有限,这有助于在正常盐水中观察到的酸干扰.
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