高渗氯化钠羟乙基淀粉40注射液及白蛋白在失血性休克患者容量治疗中的临床比较

Comparative study of hypertonic sodium chloride hydroxyethyl starch 40 and human albumin as plasma expanolers in treatment of hemorrhagic shock

目的 探讨高渗氯化钠羟乙基淀粉40注射液(HSH)及人白蛋白(HA)在失血性休克容量治疗中的临床疗效.方法 将29例简化急性生理评分(SAPSI)在15～30分,入科时收缩压＜90 mmHg的创伤患者,按随机化序列分为HSH治疗组(HSH组n=15例)持续输液,24 h给药总剂量＜500 ml;20%HA注射液治疗组(HA组n=15例)持续输液,24 h给药总剂量＜700 ml.当邻近两次收缩压达到100～120 mmHg时停止用药,并维持血液动力学等参数稳定.监测用药前及用药后不同时间内血液动力学及氧动力学参数.结果 HSH组用药后15 min开始MAP升高,心率逐步降低,到用药后15～60 min两项恢复到正常水平.两组患者经容量治疗后血液动力学及氧动力学参数与用药前基线值间差别有显著性意义(P＜0.05),HSH组溶液患者心脏指数、氧供和氧耗值较HA组明显增加,(P＜0.05),其他参数组间比较无显著差异(P＞0.05).结论 在创伤患者容量治疗中,用高渗氯化钠羟乙基淀粉40注射液在改善血液动力学和内脏器官灌注方面显著优于人白蛋白,且经济的、风险性小.

Objective To investigate the efficacy of hypertonic sodium chloride hydroxyethyl starch 40(HSH)versus human albumin(HA) as plasma expanders in treatment of hemorrhagic shock.Methods With the systolic blood pressure(SBP) under 90mmHg and the simplified acute physiology score(SAPSI) between 15 and 30,29 traumatic patients were randomly divided into two groups: one group were injected HSH(HES group,n=15) and the other group were injected 20% HA(HA group,n=14).The accumulated dose of the medicine was no more than 500 ml for HSH and 700 ml for HA a day.The parameters of haemodynamics and oxygen-dynamics of all the patients were monitored before and during the continuous injection.The medieation was discontinued when the systolic blood pressure measured for two consecutive times at a definite interval reached 100～120 mmHg.Results The mean arterial pressure in HES group began to increase at 15 minutes after administration of the drug;heart rates gradually lowered,reaching a normal level at 15～60 minutes after the medication.The hemodynamic and oxygen dynamic parameters in both groups after the medication showed significant difference from those before the medication(P<0.05).After the treatment,the levels of cardiac index(CI),oxygen delivery(DO2)and oxygen consumption(VO2)were much higher in HES group than those in HA group during treatment period,while other parameters showed no difference(P>0.05).Conclusions In plasma expanding therapy of hemorrhagic shock to improve the haemodynamics and the perfusion of internal organs,HSH seems superior to HA,more economical and lessrisky.