KEMAL TOLGA SARAÇOĞLU, Zeynep ETİ, MUSTAFA ÜMİT UĞURLU, Meliha ORHON, Fevzi Yılmaz GÖĞÜŞ

The effects of peroperatıve fluıd admınıstratıon on postoperatıve acıd-base and electrolyte balance ın patıents undergoıng total gastrectomy

Amaç: Bu prospektif klinik çalışmada total gastrektomi cerrahisi geçiren ve perioperatif %0,9 serum fizyolojik (Grup NS) ya da Ringer Laktat (Grup RL) infüzyonu alan hastalarda asid-baz ve elektrolit dengesinin karşılaştırılması amaçlanmıştır. Yöntem: Gastrik kanser tanısıyla total gastrektomi operasyonuna alınacak olan 50 hasta çalışmaya dahil edildi. Arteryel kan gazı analizleri indüksiyonu takiben, postoperatif 1, 12 ve 24. saatlerde alındı ve hastaların metabolik durumlarıyla sodyum, klorür ve potasyum değerleri kaydedildi. Bulgular: Postoperatif 1. saatte her iki gruba ait ortalama pH değerlerinde anlamlı bir düşüş, ardından 6, 12 ve 24. saatlerde bir yükselme tespit edildi. Her iki grupta da tüm zamanlarda arteryel PaCO2, PaO2, ve oksijen satürasyonu değerlerinde anlamlı bir fark gözlenmedi. RL Grubunda serum sodyum seviyeleri tüm postoperatif dönem boyunca anlamlı olarak düflüktü. Serum potasyum seviyelerinde anlamlı bir fark gözlenmedi. Grup NS ile karşılaştırıldığında RL Grubunda serum klor düzeyleri postoperatif 6, 12 ve 24. saatlerde anlamlı olarak daha düflüktü. Klor düzeyi operasyon sonu dönemle karşılaştırıldığında Grup NSde anlamlı olarak düşmüşken postoperatif 24. saatte anlamlı bir farklılık gözlenmedi. Sonuç: Metabolik durum göz önünde bulundurulduğunda hiperkloremik metabolik asidoz %0,9 serum fizyolojik verilen grupta postoperatif 1. saatte geçici bir yan etki olarak ortaya çıkmıştır. Bununla birlikte RL Grubunda hiponatremiye bir eğilim gözlemlenmiştir. Major abdominal cerrahi geçiren hastalarda %0,9 serum fizyolojik solüsyonunun güvenle kullanılabileceği kanaatindeyiz.

Total gastrektomi operasyonu geçiren hastalarda peroperatif sıvı infüzyonunun postoperatif dönemde elektrolit ve asit-baz değişiklikleri üzerine etkileri

Objective: This prospective clinical study aimed to compare acid-base and electrolyte balance in patients who were administered perioperative normal saline (group NS) or Ringers Lactate (Group RL) infusion for total gastrectomy surgery. Method: Fifty patients scheduled to have total gastrectomy surgery for gastric cancer were recruited in the study. We performed arterial blood gas analysis after induction, at 1st, 12th and 24th postoperative hours, and recorded data regarding patients metabolic conditions with sodium, chloride and potassium levels. Results: The mean pH values of Group RL and NS showed a significant decrease at the 1st postoperative hour, then an increase in the 6th, 12th and 24th hours. The arterial PaCO2, PaO2, and oxygen saturation values did not show any significant difference in both groups at all times. Serum sodium levels were significantly lower in RL Group during all postoperative period. There was not a significant difference in serum potassium levels. Serum chloride levels at postoperative 6th, 12th and 24th hours were significantly lower in RL Group than NS Group. While Chloride level decreased significantly at the 6th hour in Group NS, compared to the end of the surgery, it did not change significantly at 24th hour. Conclusion: Regarding the metabolic condition, in normal saline group, hyperchloraemic metabolic acidosis was obtained at first postoperative hour as a temporary side effect. Besides, we have observed a tendency for hyponatremia in Ringers Lactate group. We are in the opinion that normal saline infusion can be confidently used in major abdominal surgeries.

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