失血性休克手术中用佳乐斯行容量治疗的临床观察

Fluid Therapeutical Effect of Gelofusine in Patients with Hemorrhagic Shock during Surgery

目的:观察在失血性休克手术中用佳乐斯行容量治疗的临床效果。方法:选急性大失血休克在全麻下行急诊手术的患者25例。先用佳乐斯和乳酸钠林格氏液行容量治疗,然后适量输红细胞悬液和血浆,必要时使用麻黄碱和多巴胺。监测Bp、HR、SpO2、CVP、Hct、Hb和血气。结果:术前和术中失血量分别为(2 583±944)m l和(819±309)m l。从输液开始至术毕拔除气管导管时间平均为(257±92)m in。平均每例输入佳乐斯(3 323±354)m l、乳酸钠林格氏液(1971±141)m l、红细胞悬液(1 863±519)m l、血浆(518±102)m l。术中Bp,CVP,SPO2基本在正常范围。与术前相比,输血前Hb和Hct显著降低(P<0.05),拔管后Hb和Hct显著升高(P<0.05),输血前和拔管后Bp,CVP,SpO2,pH,PaO2,HCO3-和BE显著升高,HR显著降低(P<0.05)。结论:佳乐斯可有效地扩充血容量,纠正低血压,对失血性休克的救治具有较高的实用价值。

Objective： To investigate the fluid therapeutical effect of Gelofusine in patients with hemorrhagic shock during surgery. Methods： Twenty-five patients with blood loss more than 40% of total blood volume before surgery were included in this study. All the patients were quickly infused with Gelofusine and lactate Ringer＇s solution until the systolic blood pressure returned to above 90mmHg before anesthesia and then infused with Gelofusine, lactate Ringer＇s solution and blood according to the patients＇ status during the surgery. The Bp, HR, SpO2 and CVP were recorded, and the blood gas analyse Hct and Hb were measured before the infusion of Gelofusine, before the blood transfusion and after surgery. Results： The average blood loss was respectively （2 583±944） ml and （819±309） ml before and during the surgery. The average volume of Gelofusine and LR infused as well as blood transfused was （3 323±354） ml, （ 1 971±141 ） ml and （2 381±588 ） ml respectively during the average time （257±92 ） min from infusion of Gelofusine to the end of operation. The normal values of Bp, CVP, SpO2 were maintained during the operation. The values of Hb and Hct were significantly decreased before the blood transfusion and increased at the end of the surgery as compared with those before the surgery（ P 〈 0.05）. The values of Bp, CVP, SpO2, pH, PaO2, HCO3^-, and BE were increased and HR decreased significantly before the blood transfusion and at the end tithe surgery as compared with those before the surgery（ P 〈0.05）. Conclusions： The administration of Gelofusine can effectively increase blood volume and blood pressure, so it might be more effective in the patients with hemorrhagic shock.