高渗氯化钠-羟乙基淀粉用于子痫前期腰麻下剖宫产术的可行性

Application of hypertonic sodium chloride-hydroxyethyl starch solution in Caesarean section patients with preeclampsia

目的研究子痫前期产妇在腰麻下行剖宫产术时输入高渗氯化钠-羟乙基淀粉液(HSH)对产妇及新生儿的安全性。方法临床确诊子痫前期产妇30例随机分为观察组(n=20)和对照组(n=10)。观察组先输注5ml/kgHSH,再输注复方氯化钠;对照组仅输注复方氯化钠。抽取静脉血检测手术前后RBC、Hb、红细胞比容(Hct)、血小板计数(Plt)及电解质;记录术中MAP、HR、输液量、失血量、尿量和术后24h内产妇进液量与出液量;记录麻黄碱的应用例数以及新生儿1minApgar评分。结果两组RBC、Hct、Plt和血清电解质手术前后及组间差异均无统计学意义;术中HR组内、组间比较差异亦无统计学意义;两组MAP在麻醉后5、8、10min及术毕四个时点较麻醉前均明显降低(P<0·05),且观察组MAP在麻醉后四个时点均高于对照组(P<0·05);观察组术中输液量明显少于对照组,尿量多于对照组(P<0·05);而术中失血量、术后24h内输液量、尿量及新生儿Apgar评分比较差异无统计学意义。结论子痫前期产妇腰麻下行剖宫产术时输入5ml/kgHSH是安全可行的。

Objective To investigate the safety of hypertonic sodium chloride-hydroxyethyl starch solution （HSH） in Caesarean section patients With preeclampsia. Methods Thirty patients undergoing Caesarean section under spinal anesthesia were randomly divided into two groups, Experimental group（n=20） was treated with 5 ml/kg HSH followed by sodium chloride injection. Control group （n= 10） was infused sodium chloride solution only. Hb, Hct,platelet（Plt） and serum electrolytes were measured perioperatively. MAP, HR, volume of infusion, blood loss and urine output were recorded. Application of ephedrine and Apgar scores of newborn were recorded as well. Results RBC, Hct, Plt and serumal electrolytes were all not significantly changed after the operation compared with those before and between two groups. So did the change of HR during operation. Blood loss during operation and Apgar scores of twO groups were similar. Compared with that before anesthesia, MAP was significantly decreased at 5,8, and 10 rain after spinal anesthesia and at the end of Cesarean section in two groups（P〈0, 05）. The amount of infusion of experimental group was significantly less and urine output was more than that of control group（P〈0.05）. Conclusion It is safe and feasible to infuse HSH 5 ml/kg in Caesarean section patients with preeclampsia.