CAJ | 학술논문

目的探讨6％羟乙基淀粉130/0.4急性高容量血液稀释(AHH)用于学龄前患儿血液保护的效果.方法择期行普外科或骨科手术患儿40例,ASA Ⅰ级,年龄3～6岁,体重11.5 ～ 22.5kg,身高78 ～ 120 cm,按抽签的方法将其随机分为急性高容量血液稀释组(AHH组,n=20)和对照组(C组,n=20).手术开始前,AHH组经颈内静脉输注6％羟乙基淀粉130/0.4 10 ml/kg,输注速率0.3ml·kg-1·min-1；C组常规补液记录术中液体出入量、术中出血量、尿量及异体输血情况.于AHH前(T0)、AHH结束后即刻(T1)、4 h(T2)、24 h(T3)测定血常规、肝肾功能以及凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)]指标.记录术中低钾血症、低钙血症、PT延长、APTT延长和围术期肺水肿、心衰、创面异常出血等发生情况.结果与C组比较,AHH组尿量升高,T1时Hct、T12时Fib降低,PT和APTT延长,异体输血免除率、PT延长和APTT延长发生率升高(P＜0.05)；复方电解质注射液用量、失血量、肝肾功能各指标、血小板计数、低钾血症和低钙血症发生率比较差异无统计学意义(P＞0.05)；围术期均无肺水肿、心衰和创面异常出血发生.结论学龄前患儿采用6％羟乙基淀粉130/0.4 10 ml/kg行AHH时可产生较好的血液保护作用,对内环境影响较小,但可延长凝血时间.
목적 탐토6％간을기정분130/0.4급성고용량혈액희석(AHH)용우학령전환인혈액보호적효과.방법 택기행보외과혹골과수술환인40례,ASA Ⅰ급,년령3～6세,체중11.5 ～ 22.5kg,신고78 ～ 120 cm,안추첨적방법장기수궤분위급성고용량혈액희석조(AHH조,n=20)화대조조(C조,n=20).수술개시전,AHH조경경내정맥수주6％간을기정분130/0.4 10 ml/kg,수주속솔0.3ml·kg-1·min-1；C조상규보액 기록술중액체출입량、술중출혈량、뇨량급이체수혈정황.우AHH전(T0)、AHH결속후즉각(T1)、4 h(T2)、24 h(T3)측정혈상규、간신공능이급응혈공능[응혈매원시간(PT)、활화부분응혈활매시간(APTT)、섬유단백원(Fib)]지표.기록술중저갑혈증、저개혈증、PT연장、APTT연장화위술기폐수종、심쇠、창면이상출혈등발생정황.결과 여C조비교,AHH조뇨량승고,T1시Hct、T12시Fib강저,PT화APTT연장,이체수혈면제솔、PT연장화APTT연장발생솔승고(P＜0.05)；복방전해질주사액용량、실혈량、간신공능각지표、혈소판계수、저갑혈증화저개혈증발생솔비교차이무통계학의의(P＞0.05)；위술기균무폐수종、심쇠화창면이상출혈발생.결론 학령전환인채용6％간을기정분130/0.4 10 ml/kg행AHH시가산생교호적혈액보호작용,대내배경영향교소,단가연장응혈시간.
Objective To evaluate the blood-saving effect of acute hypervolemic hemodilution (AHH) with 6％ hydroxyethyl starch 130/0.4 (HES 130/0.4) in preschool children.Methods Forty ASA Ⅰ patients,aged 3-6 yr,weighing 11.5-22.5 kg,with body height of 78-120 cm,scheduled for orthopedic or general surgeries,were divided into 2 groups by drawing lots:group AHH (n =20) and group control (n =20).6％HES 130/0.4 10 ml/kg was infused over 30 min at a rate of 0.3 ml·kg-1 · min-1 through the internal jugular vein before surgery in group AHH.The fluid balance,blood loss,urine output and blood transfusion during operation were recorded.The blood routine,liver and kidney function and coagulation function (prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fib)) were measured before AHH (T0) and at 0,4 and 24 h after AHH (T1-3).Hypokalemia,hypocalcemia and prolongation of PT and APTT during surgery,and pulmonary edema,heart failure and abnormal bleeding from the site in the wound during the perioperative period were recorded.Results The two groups were comparable with regard to the volume of multiple electrolyte solution consumed,blood loss,parameters of liver and kidney function,platelet count and incidences of hypokalemia and hypocalcemia (P ＞ 0.05).The urine output was significantly increased,Hct at T1 and Fib at T1,2 were significantly decreased,PT and APTT were prolonged,and the percentage of patients without allogeneic blood transfusion and incidences of prolongation of PT and APTT were significantly increased in group AHH as compared with group C (P ＜ 0.05).No pulmonary edema,heart failure and abnormal bleeding were found during the perioperative period.Conclusion AHH with 6％ HES 130/0.4 10 ml/kg provides better blood-saving effect in preschool children,has little effect on the internal environment,but prolongs the coagulation time and exerts effect on coagulation function to some extent.