上期题目答案
支气管哮喘患者的禁忌药是（ B ）
A. 阿托品
B. *啡吗**
C. 氯胺酮
D. 丙泊酚
E.维库溴铵
你选对了吗？
不同的输液方案影响出血量吗 ？
围术期液体治疗是临床麻醉主要工作内容之一，主要满足术前禁食禁饮所欠的液体量、生理需要量、第三间隙量及手术失血量等，还满足酸碱电解质的平衡所需。恰当的输液有利于患者的康复，对于循环稳定、出凝血功能、酸碱平衡等都有重要的影响。常用的输液的种类有晶体液的0.9%NS、5%GS、5%GNS、10%NaHCO3等，胶体液有羟乙基淀粉溶液、明胶溶液、白蛋白等。
那么不同的输液方案（包括量和种类）对手术出血量有影响吗？
有学者对此展开了临床研究，结果如何呢？
我们又能从中受到什么启发呢？
平衡胶体溶液能减少小儿心脏手术围手术期出血吗：
一项双盲随机对照试验
⛳ ️背景
不平衡的液体溶液会导致代谢性酸中毒，可能与凝血功能受损和失血增加有关。
⛳ ️目的
该研究的目的是探讨在接受心脏手术的儿童中使用平衡胶体溶液与盐水胶体溶液进行围手术期液体治疗是否与失血量减少和暴露于血液制品减少有关。
⛳ ️试验设计
双盲随机对照试验。
⛳ ️试验开展
该研究于2013-2016年在某三级儿童医院开展。
⛳ ️患者
29天以上3岁以下、接受体外循环（CPB）下心脏手术的儿科患者。
排除标准：急诊心脏手术、垂死（ASA5级）、耶和华见证会、凝血障碍、肾功能衰竭、肝损伤、颅内出血和电解质紊乱。
从128名符合条件的患者中，88人被纳入研究。
⛳ ️干预
在术后第一个48小时内，将患者随机分配到生理盐水胶体（6%羟乙基淀粉130/0.4溶于0.9%NaCl）或平衡电解质胶体（6%羟乙基淀粉130/0.4溶于等渗溶液）进行CPB预充和术中及术后液体治疗。
⛳ ️主要测量指标
主要观察指标是计算术后第三天（POD3）的出血量。
⛳️结果
每个研究组共包括44名患者。
两组之间在POD3时计算的失血量没有显著差异（生理盐水胶体组19.9[IQR 13.8至26.1]ml/kg对比平衡胶体组15.9[IQR 9.0至25.3] ml/kg，P=0.409）。
与出血、使用血液制品和凝血相关的次要结果在两组之间没有差异。
两组间的机械通气时间、重症监护时间和住院时间也没有差异。
⛳ ️结论
与生理盐水胶体溶液相比，平衡胶体溶液用于围手术期液体治疗与减少失血或使用血液制品无关。
Does a balanced colloid decrease perioperative blood loss in paediatric cardiac surgery
A double-blinded randomized controlled trial?
BACKGROUND
Unbalanced fluid solutions cause metabolic acidosis and could be associated with impaired coagulation and increased blood loss.
OBJECTIVE
To investigate whether the use of a balanced colloid compared with a saline colloid for peri-operative fluid therapy in children undergoing cardiac surgery is associated with decreased blood loss and exposure to blood products.
DESIGN
Double-blinded randomised controlled trial.
SETTING
Tertiary children's hospital from 2013 to 2016.
PATIENTS
Children older than 29 days and younger than 3 years admitted for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria were emergency cardiac surgery, moribund (American Society of Anesthesiologists 5), Jehovah's witnesses, coagulopathy, renal failure, liver injury, intracranial haemorrhage and electrolyte disturbances. From the 128 patients eligible, 88 were included in the study.
INTERVENTION
Random assignment of patients to either a saline colloid (6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) or a balanced-electrolyte colloid (6% hydroxyethyl starch 130/0.4 in an isotonic solution) for CPB priming and intra- and postoperative fluid therapy during the first postoperative 48 h.
MAIN OUTCOME MEASURE
The primary outcome measure was calculated blood loss until the third postoperative day (POD3).
RESULTS
A total of 44 patients were included in each study arm. Calculated blood loss at POD3 was not significantly different between the groups (saline colloid 19.9 [IQR 13.8 to 26.1] ml kg−1 versus balanced colloid 15.9 [IQR 9.0 to 25.3 ml kg−1], P = 0.409). Secondary outcomes related to bleeding, exposure to blood products and coagulation were not different between groups. There was also no difference in length of mechanical ventilation, intensive care and hospital length of stay between groups.
CONCLUSION
The use of a balanced colloid for peri-operative fluid therapy compared with a saline one is not associated with decreased blood loss or exposure to blood products.
本期题目
患儿，12月龄，体重10KG，术前红细胞比容是36%，可接受的最低血细胞比容是25%，允许的最大失血量是（ ）
A. 220ML
B. 245ML
C. 350ML
D. 110ML
E. 无法计算