胶体液在手术中的应用

Application of Colloidal Injection During Operation

目的 :观察 6 %贺斯 (HAES)、血定安、菲克雪浓三种胶体液用于手术麻醉中的临床效果。方法 :ASAI～II级择期手术病人 30例 ,年龄 2 4～ 6 8岁 ,体重 5 1～ 83kg ,随机分为三组 ,每组 10例 ,I组输入 6 %贺斯 ;II组输入血定安 ;III组输入菲克雪浓 ;病人于麻醉前 30min内输完胶体液 5 0 0ml,所有病人均行气管插管 ,接麻醉机吸入异氟醚维持麻醉 ,用DATEX多功能监测仪监测扩容前后BP、ECG和SPO2 ,并于扩容前和扩容后即刻、4h测定病人Hb、Hct、K+ 、Na+ 、Cl-及血糖水平。结果 :三组病人扩容前、后收缩压、舒张压、心率及SPO2 变化均无明显统计学差异 (P >0 0 5 ) ;三组病人扩容前Hb、Hct水平明显高于扩容后和麻醉后 4h(P <0 0 5或P <0 0 1) ;扩容后 4h三组患者血糖水平明显高于扩容前水平 (P <0 0 1) ;三组病人K+ 、Na+ 、Cl-水平于围手术期均无明显变化。Ⅰ组病人术中无 1例发生不良反应 ,Ⅱ、Ⅲ组各有 1例病人术中出现皮疹。结论 :血液稀释是一种节约血源 ,减少血源性传播疾病的方法 ,三种胶体液均可进行急性高容量血液稀释 ,尤以 6 %贺斯为佳。

Objective:To investigate the clinical effects of acute hypervolemic hemodilution (AHH) with 6% hydroxyethyl starch (HAES) , gelofusine, and polygeline during operation. Methods: Thirty ASA I～II patients (aged 24～68 years, body weight 51～83kg) undergoing selective surgery were randomized to one of three groups, with 10 patients each.The patients in different group were infused with 6% HES (group I), gelofusine (group II) and polygeline (group III) , respectively. Anesthesia was induced with midazolam (1mg/kg), fentancyl citrate (0.2mg), pipecuronium (0.1mg/kg), and propofol (1.5mg/kg) and maintained with isoflurance after tracheal intubation. Bp, ECG, and SPO 2 were monitored before and after AHH by DATEX. Hb, HCT ,the level of K+, Na+ , Cl- , and glucose in plasma were measured before and 0, 4h after infusion was started. Results:There was no significant change in systolic pressure (SP),diastolic pressure (DP), heart rate, SPO 2 and the level of K+, Na+ , Cl- before and after AHH. Hb and HCT levels were significantly higher than that after AHH and 4h after anesthesia (P<0.05 or P<0.01). Glucose level 4h after AHH was significantly higher than that before AHH (P<0.01). Two patients happened the side effect in groups II and III. Conclusion:AHH can save blood and decrease hematogenic infectious disease during operation. All of them can be used in AHH, but HAES is the best.