Effect Of Sodium Potassium Magnesium Calcium And Glucose Injection On Internal Environment And Metabolism Of Glucose,Fat And Protein In Patients Undergoing Meningioma Surgery

Objective:To evaluate the effects of sodium potassium magnesium calcium and glucose?SPMCG?injection on internal environment,glucose?fat and protein metabolism in patients undergoing meningioma surgery.Methods:Forty-six ASA I or ? patients with meningioma aged 18 to 65 yr.with a body mass index of 18-30 kg/m2,undergoing meningioma resection surgery,were divided into 2 groups?n=22 each?:the Lactated Ring's group?L?and Sodium potassium magnesium,calcium and glucose injection group?S?using a random number table.The hemoglobin should more than 100g·L with hematocrit not less than 30%.The Glasgow scores were 15 points.The fluid replacement regime included five parts:the were,physiological requirements,compensatory volume expansion,continued loss,extra supplement amount and cumulative loss.Before anesthesia induction,6%hydroxyethyl starch 130/0.4 was infused intravenously at 15 ml·kg^-1·h^-1 for 30 min,followed by iv infusion of 6%hydroxyethyl starch 130/0.4 and corresponding volume of crystalloid solution in a ratio of 1:2 at a rate of 5^-10 ml·kg^-1·h^-1 until the end of surgery.Central venous pressure?CVP?was maintained between 5 to 12 cmH20,and urine volume should be more than 0.5ml·kg^-1h-intraoperative.Patients were given a blood transfusion if the blood loss was more than 20%of their blood volume or Hb<7.0g/dL during surgery.Insulin was joined into the liquid according to the sugar?g?:insulin?U?=4:1if the blood glucose concentration was higher than 11.1mmol/L.The number and percentage of insulin using in each group were recorded.Hemodynamic parameters,blood glucose,lactic acid concentration and arterial blood gas were assessed before anesthesia induction?T0?.intubation?T1?,beginning of operation?T2??2 hours after the beginning of operation?T3?,the end of operation?T4?and 1 hour after the operation?Ts?.Venous blood samples were collected from the central vein at To and T4.Ketone bodies???hydroxyl butyric acid?were measured by enzymatic techniques.The plasma insulin level was determined by chemiluminescence method,and the plasma 3-MH level was measured by high-performance liquid chromatography.Results:One patient withdrew from the study due to intracranial hemorrhage underwent secondary surgery in group L.And one case in group S withdrew from the study because of large amount of bleeding?about 2000ml?and long operation time?more than 11 hours?.No complications such as cerebral edema and cerebral infarction were found in all the patients who had postoperative CT examination.There was no significant difference between the two groups of patients with general information and intraoperative hemodynamic The general information and hemodynamic parameters of the two groups?P>0.05?.The electrolyte concentration was not significantly different except for Mg²⁺;on time points T2-5 in group L,Mg²⁺ concentration was significantly lower than that in group S?P<0.05?.Comparison of blood glucose concentration:one patient used the insulin due to the high blood glucose concentration?>11.1mmol/L?,the ratio was about 4.5%.Blood glucose concentration was statistically increased at T2-5 compared to To time point in both groups?P<0.05?.But there was no difference at each time point between groups?P>0.05?.Comparison of lactic acid concentration:compared with T0,there was no significant change in blood lactate concentration in group S,while in group L on T2-5 time point the blood lactate concentration was obviously increased,the difference was statistically significant?P<0.05?.In both groups the serum insulin concentrations were higher at T4 than T0?P<0.05?.When compared with T0 in group L,the blood ketone body and 3-methyl histidine?3-MH?concentrations were significantly higher on time point T4,and also higher than group S?P<0.05?.Conclusion:Sodium potassium magnesium calcium and glucose injection used in the patients undergoing meningioma surgery can maintain a stable internal environment,it contains 1%of glucose inhibits the body's fat and protein decomposition,under normal infusion speed does not cause hyperglycemia and glucose metabolic disorders.