关键词: 复方苹果酸林格液, 肝部分切除术围手术期, 肝缺血保护

Abstract: Objective To compare the effects of Ringer's malate solution and Ringer's lactate solution on the hemodynamics, intraoperative environment, liver reserve function, liver and kidney biochemical function and health economics in the operation, and to evaluate the effects of Ringer's malate solution on the recovery of liver and kidney function in patients during perioperative period.Methods In the randomized controlled double blind study, 50 patients with liver tumor resection were randomly assigned to 2 groups of Ringer's lactate (RL) solution or Ringer's malate (RM) solution. General data of the patients, operative procession and treatment records were collected and the differences in the related indexes of the 2 groups were statistically analyzed.Results There was no statistical difference between the 2 groups in sex, age, body mass index, American Society of Anesthesiologists (ASA) classification, operation time, blocking time, bleeding volume, transfusion volume, infusion volume, and the number of liver segments (P>0.05). The average arterial pressure and the central venous pressure showed no statistical differences between the 2 groups at the moment after anesthetic induction (T1), the time of hepatic portal occlusion (T2), the time of hepatic portal patency (T3) and 40 minutes after hepatic portal patency (T4) (P>0.05). The value of pH, arterial blood glucose and arterial lactate levels at T3 and T4 time points in the 2 groups were statistically different (P<0.05). At the time of T1, T3 and T4, there was no statistical difference in the ion concentrations of potassium, sodium, calcium and chlorine between the 2 groups (P>0.05). Compared to that at T1 time point, indocyanine green plasma disappearance rate (ICG PDR) at T4 time point was significantly decreased [RL group (18.73±1.97 vs. 13.48±2.79, P=0.000), RM group (19.64±2.47 vs. 14.62±2.74, P=0.000)], while R15 was significantly increased [RL group (7.06±1.51 vs. 12.02±2.24, P=0.000), RM group (6.26±1.91 vs. 10.53±3.40, P=0.000)]. On the first day after operation, the differences of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) between the 2 groups were statistically significant (AST: 414.32±213.60 vs 304.52±152.15, P=0.042; ALT: 443.88±239.53 vs 305.32±190.46, P=0.029), and other indexes of liver and kidney function showed no significant difference. Moreover, there was no statistical difference between the liver and kidney function indexes at the second day after the operation (P>0.05). There was no statistical difference in hospitalization days and total hospitalization cost between the 2 groups (P>0.05).Conclusion Ringer's malate solution can provide better internal environment stability and reduce liver damage after liver surgery.

Key words: Ringer’s malate solution, Perioperative period, Hepatic ischemia