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- 저자 : ( Chung Cheen Chai ) (검색결과 1 건)
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( Wei Ying Jen ),( Margaret L Teng ),( Wee Chuan Hing ),( Valerie Ma ),( Shridhar Ganpathi Iyer ),( Chung Cheen Chai ),( Horng Ruey Chua ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Premixed hypotonic solutions of 0.33% saline + 5% dextrose + 10mmol/ L potassium-chloride (0.33S, tonicity 133mEq/L) and 0.9% saline ±dextrose (NS, tonicity 308mEq/L) are common peri-operative maintenance fiuids, but their effects on serum biochemistry are unclear. Methods: Using a single-centre, prospectively-maintained electronic database, we retrospectively examined post-operative biochemistry in adults maintained on exclusively 0.33S or NS peri-operatively, from March 2012 to September 2013. Outcomes included new-onset post-operative hyponatremia, hypokalaemia, hypoglycaemia, and acute kidney injury (AKI, =1.5x increase in serum creatinine); multivariate analyses were adjusted for demographics, comorbidities, surgery-types/duration, infusion time/ volumes, and hospital length-of-stay. Results: We studied 279 patients given 0.33S, and 279 NS controls matched for cumulative infusion volume. Mean age was 59(±18) years. More NS patients had diabetes mellitus, ischemic heart disease and chronic kidney disease (p<0.05). Surgery types included gastrointestinal/hepatobiliary (43%), orthopaedic (30%) and nephrectomy (3%). Mean fi uid volumes administered were 6.9(±3.3)L of 0.33S and 7.1(±5.6)L of NS (p=0.57), with 100% versus 52% of drips containing dextrose, respectively. More 0.33S patients (versus NS) developed hyponatremia (30% versus 17%, p<0.001); this difference was signifi cant for gastrointestinal/hepatobiliary (p=0.001) but not orthopaedic (p=0.74) surgeries. Less 0.33S patients (versus NS) had hypokalaemia (1% versus 10%, p<0.001), hypoglycaemia (1% versus 4%, p=0.01), and AKI (3% versus 8%, p=0.007). On multivariate analyses, 0.33S, gastrointestinal/hepatobiliary surgeries and nephrectomy were independently associated with hyponatremia; while NS, hypertension, longer infusion hours, and nephrectomy were independently associated with AKI (p<0.05). Conclusions: 0.33S infusion in post-surgical patients, especially post-gastrointestinal/ hepatobiliary surgeries, is strongly associated with hyponatremia, but with less hypokalaemia or hypoglycaemia, compared with NS. The association between NS administration and AKI is heavily confounded by baseline comorbidities and requires further prospective evaluation. Both fi uid types are not appropriate for isolated use, and more balanced maintenance fi uids are desired.
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