CAJ | 학술논문

目的观察应用高渗氯化钠羟乙基淀粉40注射液(HH40)行血液稀释对胃癌根治术患者血流动力学、血电解质及体液平衡的影响.方法选取全麻下行胃癌根治术患者60例,随机分为高渗氯化钠羟乙基淀粉组(Ⅰ组)和生理盐水组(Ⅱ组),各30例.在手术进腹后达到麻醉深度稳定[脑双频指数(BIS)在55 ～65]时,分别给予HH40和生理盐水4 mL/kg行血液稀释,25 ～ 30 min输完.术中维持BIS为55 ～ 65.应用FloTrac/Vigileo (FV)心排血量监测系统监测心输出量(C0)、每搏输出量(SV)、每搏变异度(SVV)、平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)等血流动力学参数,分别在人室后30 min(麻醉前基础值,T0)、血液稀释前(T1)、血液稀释后即时(T2)、稀释后30 min(T3)、稀释后60 min(T4)及稀释后120 min(T5)记录各项指标.经桡动脉采取血样测定T1、T2、T3、T4及T5时点患者的血钾及血钠浓度.统计总输液量、尿量、出血量及使用麻黄碱例次,观察有无出现过敏或肺水肿征象.结果 Ⅰ组在行血液稀释后(T2)MAP、CO、SV较血液稀释前(T1)明显升高,较对照组也显著升高(P＜0.01).Ⅰ组在输注HH40 30 min后(T3)SVV值较Ⅱ组明显降低(P＜0.05).Ⅰ组的血钠浓度在血液稀释后较前升高,与Ⅱ组比较亦较高(P＜0.05),但尚在正常范围,120 min后(T5)与Ⅱ组比较差异无统计学意义(P＞0.05).Ⅰ组的尿量较Ⅱ组明显增加(P＜0.05).结论术中以HH40行血液稀释能有效维持患者的血流动力学稳定,在不增加输液量的情况下增加了肾脏灌注使患者尿量明显增加,对肾功能有保护作用.
목적 관찰응용고삼록화납간을기정분40주사액(HH40)행혈액희석대위암근치술환자혈류동역학、혈전해질급체액평형적영향.방법 선취전마하행위암근치술환자60례,수궤분위고삼록화납간을기정분조(Ⅰ조)화생리염수조(Ⅱ조),각30례.재수술진복후체도마취심도은정[뇌쌍빈지수(BIS)재55 ～65]시,분별급여HH40화생리염수4 mL/kg행혈액희석,25 ～ 30 min수완.술중유지BIS위55 ～ 65.응용FloTrac/Vigileo (FV)심배혈량감측계통감측심수출량(C0)、매박수출량(SV)、매박변이도(SVV)、평균동맥압(MAP)、심솔(HR)화중심정맥압(CVP)등혈류동역학삼수,분별재인실후30 min(마취전기출치,T0)、혈액희석전(T1)、혈액희석후즉시(T2)、희석후30 min(T3)、희석후60 min(T4)급희석후120 min(T5)기록각항지표.경뇨동맥채취혈양측정T1、T2、T3、T4급T5시점환자적혈갑급혈납농도.통계총수액량、뇨량、출혈량급사용마황감례차,관찰유무출현과민혹폐수종정상.결과 Ⅰ조재행혈액희석후(T2)MAP、CO、SV교혈액희석전(T1)명현승고,교대조조야현저승고(P＜0.01).Ⅰ조재수주HH40 30 min후(T3)SVV치교Ⅱ조명현강저(P＜0.05).Ⅰ조적혈납농도재혈액희석후교전승고,여Ⅱ조비교역교고(P＜0.05),단상재정상범위,120 min후(T5)여Ⅱ조비교차이무통계학의의(P＞0.05).Ⅰ조적뇨량교Ⅱ조명현증가(P＜0.05).결론 술중이HH40행혈액희석능유효유지환자적혈류동역학은정,재불증가수액량적정황하증가료신장관주사환자뇨량명현증가,대신공능유보호작용.
Objective To observe the effect of hemodilution with hypertonic sodium chloride hydroxyethyl starch 40 injection (HH40) on the electrolytes,hemodynamics and fluid balance of patients treated by radical correction of gastric cancer.Methods Approved by hospital ethics committee.A total of 60 patients who treated by radical correction of gastric cancer under general anesthesia at our hospital were randomly divided equally into 2 groups:group Ⅰ (hemodilution) and group Ⅱ (control) (n =30each).After the abdominal cavity was opened and the depth of anesthesia is stable (Bispectral index (BIS) value is maintained at 55-65),hypertonic sodium chloride hydroxyethyl starch 40 injection was infused at the total of 4 ml/kg in group Ⅰ,while patients in group Ⅱ received saline at the total of 4 m]/kg,finished between 25 and 30 minutes.Regulating the depth of anesthesia according to BIS values (55-65)intraoperative.Cardiac output (CO),stroke volume (SV),every stroke variability (SVV),mean arterial pressure (MAP),heart rate (HR) and central venous pressure (CVP) were recorded at the following time points:T (0) (base) (before induction),T (1) (after induction and hemodynamic stabilization),T (2) (when the infusion is finished),T (3) (after infusion for 30 min),T (4) (after infusion for 60 min) and T (5) (after infusion for 120 min).Blood samples from radial artery were collected and determine the potassium and sodium concentration at the following time points:T (1),T (2),T (3),T (4) and T (5).Add up the total fluid volume,urine output,amount of bleeding.The dosing frequency of ephedrine was also recorded,to observe the presence or absence of signs of allergy and pulmonary edema.Results MAP,CO and SV at time point T2 in group Ⅰ were significantly higher than that at time point T1,and were significantly higher than that at T2 in group Ⅱ (P ＜ 0.01).SVV in group Ⅰ was significantly lower than that in group Ⅱ (P ＜ 0.05) at the time point T3.[Na +] i in group Ⅰ was significantly higher than that in group Ⅱ after hemodilution (P ＜ 0.05),but no significant difference was found at the time point T5 between groups.The urine output,in group Ⅰ was significantly more than that in group Ⅱ (P ＜0.01).Conclusion The patient' s hemodynamic stability can be effectively maintained.After the hemodilution with HH40,it will increase renal perfusion without increase the total fluid volume,the urine volume increased significantly.Therefore,the patient' s function of kidney can be effectively protected.