【作者】 邱冬梅；

【导师】 钟麟；

【作者基本信息】 四川大学 ， 外科学， 2007， 硕士

【摘要】 目的：探讨小儿择期腹部大中型手术前后电解质变化的特点及临床意义。方法：对57例行择期腹部大中型手术患儿按照年龄、手术大小分为A、B、C、D四组。A组为年龄≤3岁患儿组，19例；B组为年龄＞3岁、≤14岁患儿组，38例；C组为大型手术组，28例；D组为中型手术组，29例。分别于术前1天和术后前3天清晨抽取空腹静脉血，检测术前及术后不同时间电解质变化的数据。4次所抽取静脉血时患儿均未使用影响血钾、钙、镁的药物，术前术后补液采用5％GS和10％GS，术后按丢失量和生理需要量补充5％GNS。对手术前后血清电解质检测结果进行统计学分析。结果：小儿择期腹部大中型手术后血钾较术前有明显下降(P＜0.01)，无高血钾出现，血钠、氯、钙、镁无明显变化(P＞0.01)；年龄大小与血钾的改变有明显的相关性(P＜0.05)，年龄越小，越容易引起血钾的变化，而血钠、氯、钙、镁的改变差值无显著性(P＞0.05)；手术大小对电解质的变化无明显相关性(P＞0.05)。结论：只要患儿肾功能正常，腹部手术后第一天就应该开始见尿补钾，而且早期补钾，有利于患儿术后肠道功能早恢复，减少腹胀、肠麻痹，甚至肠梗阻、切口裂开等并发症，而不需常规补钙和镁。钠和氯术后按照生理需要量和丢失量补充，就可以达到维持血钠和血氯的平衡。更多还原

【Abstract】 Objective: To explore serum electrolyte changes characteristics and clinicalmeaning before and after major and medium scheduled abdominal surgery ofchildrenMethods: 57 children undergoing major and medium scheduled abdominalsurgery were divided into 4 groups（A,B,C,D） according to age andoperation degree. Group A is 19 cases（aged 0-3yr）, group B is 38 cases（aged 3-14yr）,group C （major surgery）is 28 cases and group D（mediumsurgery） is 29 cases. The serum electrolyte were detected before operationfirst day and 1-3 days postoperatively. The children hadn’t used medicine ofinfluencing K⁺,Ca²⁺ and Mg²⁺. The children had been drip 5％GS and10％GS before and after operation, and add 5％GNS by lost and needed tomeasure. The results were analyzed with the spss 13.0.Results: After surgery the levels of K⁺ were decreased dramatically（P＜0.01） and hyperkaliemia didn’t happen, with no distinctive change inNa⁺,Cl^-, Ca²⁺ and Mg²⁺（P＞0.01）. The conspicuous correlationbetween age and serum potassium change was detected（P＜0.05）. The ageis more young, causing the variety of serum potassium morn and easily.But the blood sodium, chlorine, calcium, magnesium change was not significant（P＞0.05）. The surgical operation magnitude has no obviousrelativity to the variety of electrolyte（P＞0.05）.Conclusion: With normal renal function potassium supplement might beginon the first day when the patient begins to urinate. Then that isadvantageous to promote a bowel way function instauration, to decreasecomplication such as abdominal distention, enteroparalysis, bowelobstruction, disruption of wound, et al. But it isn’t need to supply calciumand magnesium after operation routinely. Sodium and chlorine supplementaccording to losing amount and the physiology needs can retain the balanceof serum sodium and chlorine after operation.更多还原