CAJ | 학술논문

目的由于血液流变学特性是影响血液循环的重要因素,而妊娠期存在明显的血液流变学改变,因此该文研究中分子羟乙基淀粉(贺斯)对剖腹产患者术中血液流变学影响.方法选择ASAⅠ～Ⅱ级剖腹产手术患者40例,行连续硬膜外麻醉.开放前臂静脉,以10ml/(kg·h)的速度持续输液,榆平衡液500ml后开始硬膜外腔注局麻药,并根据继续补液性质的不同将患者随机分成两组,即平衡液组(B组,n=20)和贺斯组(H组,n=20).监测记录HR、MAP、SpO2的变化情况,记录手术结束时的失血量、尿量.并于输注治疗药前和输注治疗药后(手术结束时)采输注治疗药对侧前臂肘静脉血样5 ml,EDTA抗凝,送检血液流变学指标.结果全血低、中切粘度,H组与B组比较降低明显;而血浆粘度B组有明显降低,但H组无明显变化.无论是H组还是B组全血还原低切粘度均有明显降低,但H组比B组更明显,两组间比较差异显著;全血还原中切粘度、血沉方程K值变化在B组不明显,H组则明显降低;红细胞聚集指数两组均见明显降低,但H组比B组降低更明显,两组间比较差异非常显著;纤维蛋白原数量无论是B组还是H组均有非常明显减少.结论贺斯改善剖腹产患者术中血液流变学功能方面优于晶体液-平衡液.剖腹产手术患者适当应用胶体液-贺斯,有利于血液流变学改善,从而改善微循环.
목적유우혈액류변학특성시영향혈액순배적중요인소,이임신기존재명현적혈액류변학개변,인차해문연구중분자간을기정분(하사)대부복산환자술중혈액류변학영향.방법선택ASAⅠ～Ⅱ급부복산수술환자40례,행련속경막외마취.개방전비정맥,이10ml/(kg·h)적속도지속수액,유평형액500ml후개시경막외강주국마약,병근거계속보액성질적불동장환자수궤분성량조,즉평형액조(B조,n=20)화하사조(H조,n=20).감측기록HR、MAP、SpO2적변화정황,기록수술결속시적실혈량、뇨량.병우수주치료약전화수주치료약후(수술결속시)채수주치료약대측전비주정맥혈양5 ml,EDTA항응,송검혈액류변학지표.결과전혈저、중절점도,H조여B조비교강저명현;이혈장점도B조유명현강저,단H조무명현변화.무론시H조환시B조전혈환원저절점도균유명현강저,단H조비B조경명현,량조간비교차이현저;전혈환원중절점도、혈침방정K치변화재B조불명현,H조칙명현강저;홍세포취집지수량조균견명현강저,단H조비B조강저경명현,량조간비교차이비상현저;섬유단백원수량무론시B조환시H조균유비상명현감소.결론하사개선부복산환자술중혈액류변학공능방면우우정체액-평형액.부복산수술환자괄당응용효체액-하사,유리우혈액류변학개선,종이개선미순배.
Objective: To investigate influence of medium molecular weight hydroxyethyl starch on hemorheology in patients with Cesarean section. Methods:Forty patients , ASA grade Ⅰ - Ⅱ, scheduled for Cesarean section by epidural anaesthesia were divided randomly into two groups: group B (n = 20) received the balanced salt solution (BS) and group H (n=20) received HS for liquid therapy. Blood was taken from upper arm vein for determination of hemorheology outcome at the beginning and the end of BS or HS administration. Results: Compared with the group B , the viscosity of blood in group H under the condition of low shear rate (cp: 10 s- 1 ) and middle shear rate (cp:60 s-1) decreased significantly; the viscosity of plasma of group B decreased obviously , but it didn't change significantly in the group H. Viscities of blood of both groups under the condition of low shear rate decreased significantly, but viscosity of blood of group H decreased more significantly and the difference between two groups wassignificant. The viscosity of blood of group H under the condition of middle shear rate and ESR - K value of group H decreased significantly , but they didn't change significantly in group B. The erythrocyte aggregation index of both groups decreased significantly, but it decreased more significantly in group H and the difference between two groups was significant. Meanwhile the concentration of fibrinogen of both groups decreased significantly. Conclusions:Compared with BS, effect of HS is better on improving hemorheology in patients with Cesarean section.