泌尿器科領域における手術前後の水分,電解質,酸塩基平衡について

Abstract

Serum nitrogen substances, serum electrolytes, urinary electrolytes, urine volume, hematocrit, and blood acid-base balance were examined before and after urologic surgery in order to establish a rational criteria of fluid therapy during and after operation. 1. Postoperatively, transient elevation of serum nitrogen substances and decrease of serum Na, Cl, HCO3 were noted. Urinary excretion of sodium tended to decrease and that of potassium increase, thus making high Uk/UNa ratio. 2. Cases of renal surgery were divided into normal renal function group (N) and impaired renal function group (I). Each was subdivided into young (Y) and aged cluster (A). Postoperative increase of serum nitrogen substances was more striking in group I than in group N. There was, however, no difference between group N and group I as to water, electrolytes and acid-base balance. Acidosis was more marked in group N than in group I. In group I, cluster-Y showed acidosis more prominent but slighter elevation of serum nitrogen substances than cluster-A. 3. Cases of other operations were studied in the similar manner. There was no remarkable difference between group N and group I. In group N, cluster-Y showed smaller changes in serum nitrogen substances and electrolytes than cluster-A. In group I, cluster-A did not show decrease of sodium excretion as cluster-Y did. 4. When non-electrolyte fluid was infused during operation, postoperative elevation of serum nitrogen substances was influenced by amount of sodium administration after surgery. The cases administered 65 to 82 mEq of sodium showed the slighter elevation than the cases administered less. Metabolic acidosis was of similar tendency as nitrogen substances. Elevation of UK/UNa ratio was suppressed by sodium administration. 5. When Ringer's lactate was administered during operation and 107 to 180 mEq of sodium postoperatively, increase of the serum nitrogen substances as well as changes in serum electrolytes and acid-base balance was minimal. Urinary sodium excretion was also kept undiminished. 6. Based upon above results, criteria were established as to quality and quantity of fluid administration during and after operation. More sodium administration was suggested than used to be indicated; namely, more than 100 mEq/day was thought to be adequate.