6%羟乙基淀粉应用于卵巢癌肿瘤细胞减灭术中液体治疗的有效性及安全性评价

Efficiency and safety of the administration of 6% hydroxyethyl starch as fluid therapeutic regimen during cytoreductive surgery of ovarian carcinoma

目的评估6%羟乙基淀粉(6%HES,200/0.5)液体治疗的有效性和安全性.方法40例拟行卵巢癌肿瘤细胞减灭术病人随机均分为两组:失血量超过预估血容量的10%时,HES组使 用等量6%HES扩容;晶体液(Crys)组用3倍复方氯化钠补充血容量.诱导后30 min和手术开始后60、120、180min测定心率(HR)、有创动脉压(ABP)、中心静脉压(CVP)、血气、电解质浓度和血、尿渗透压及胃粘膜pH值(i-pH).同时记录手术前后的血清天门冬氨酸氨基转移酶(AST)、谷氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶(GGT)、肌酐(Cr)、术中和术后24 h尿量及凝血机制(PT、PA)的变化.结果HES组MAP在手术160、170 min时明显高于Crys组(P＜0.05);手术90～170 min时,HES组病人CVP高于Crys组(P＜0.05);手术180 min时,HES组的i-pH低于Crys组(P＜0.05).HES组术后血淀粉酶水平明显升高(P＜0.05);两组病人术后PT和PA均有明显改变(P＜0.05),但仍在正常范围之内.结论6%HES作为容量替代治疗用品是安全有效的,但肾功能不全病史、凝血机制障碍的病人,应注意相关功能指标的监测.

Objective To evaluate the efficiency and safety of the administration of 6% hydroxyethyl starch as fluid therapeutic regimen. Methods Forty patients undergoing cytoreductive surgery of ovarian carcinoma were randomly divided into HES group （n= 20） and Crys group （n= 20）. When the blood loss was larger than 10% of the estimating intravascular volume, the patients of HES group received the infusion of 6 % hydroxyethyl starch as the same volume of blood loss, and the patients of Crys group received the infusion of three times volume of Ringer＇s solution. The MAP, CVP and HR were recorded every 10 min during operation. The measurement of i-pH, the concentration of electrolyte, osmotic concentration of urine and serum and the blood gas analysis were performed at 30 min after induction,60,120,180 min after the operation began. Meanwhile, the preoperative and postoperative serum concentration of ALT, AST, GGT, Cr, amylase and PT, PA were recorded. Results The MAP in HES group was higher than that in Crys group at the 160, 170 min （P〈0.05）, and CVP was higher at 90-170 min （P〈0.05） . The i-pH was higher in HES group at 180 min after the beginning of operation （P〈 0.05）. The postoperative PT increased and PA decreased significantly in both groups, compared with preoperative value （P〈0.05）. The amylase increased significantly only in HES group（P〈0.05）. Conclusion As a blood substitue administrated during the major operation, 6% hydroxyethyle is a safe and effective fluid, except the patients with renal dysfunction, abnormal coagulation.