术中大剂量输入聚明胶肽注射液临床应用观察

Intraoperative infusion of large-volume Polyegline

目的观察聚明胶肽注射液大剂量输入对手术患者凝血功能、肾功能及电解质的影响。方法选择ASAⅠ—Ⅱ级择期非心脏手术患者80人,术中输入聚明胶肽注射液2000—3000ml,监测血压、心率和脉搏氧饱和度(SpO2)、聚明胶肽注射液大剂量输入前后血常规(WBC、RBC、Hct、Hb、P lt)、电解质浓度(Na+、K+、Ca2+)、凝血图(APTT、PT、TT)及用药前及停药24h血尿素氮(BUN)和血清肌酐(SCr)浓度。结果80名手术患者聚明胶肽注射液用量为(2 200±324)ml,血压、脉搏、SpO2均在正常值范围内波动;聚明胶肽注射液大剂量输入后RBC、Hct、Hb、P lt明显低于用药前基础值,WBC计数则明显增加(P<0.01),APTT、TT、PT明显降低(P<0.01),变异率分别为8.8%、10%、2.5%,但无明显临床表现;Na+、K+浓度明显增加(P<0.05),Ca2+浓度无统计学差异(P>0.05),均在正常值范围内波动;BUN和SCr与基础值比较无统计学意义(P>0.05);血液稀释度与APTT、PT差值的相关系数(r)分别为0.3012、0.3407(P<0.05),试验药物用量(38.45±4.96)与APTT、PT差值的相关系数(r)分别为0.1791、0.1901(P>0.05)。结论输入聚明胶肽(2000—3000)m l/d,对手术患者肾功能及电解质没有明显影响,对凝血功能影响较轻微,其原因可能与血液稀释有关。

Objective To evaluate the safety of large-volume Polyegline infusion and its influence on coagulation and kidney functions and electrolytes. Methods Eighty ASA Ⅰ-Ⅱ patients scheduled for elective non-cardiac surgery were infused with Polyegline （at least 2000 ml） during the surgery. Blood pressure （BP） , Heart rate （HR） and SpO2 were monitored. Blood cell counts, plasma concentrations of electrolytes and coagulation function were measured before and after the operation. Blood urea nitrogen and serum creatinine were measured before and 24 hours after tile surgery. Results BP, HR, and SpO2 were all within normal range. No significant changes were found in BP, HR and SpO2 during the surgery, in comparison with the base line. Two to three thousand milliliters of Polyegline was infused during the operations, with the average of （2 200 ± 324 ） ml. After the infusion, RBC, Hb, Hct, and Pit were significantly lower than the base llne, while the WBC count increased （P 〈 0.01 ）. APTT, PT and TF significantly decreased compared with the preoperative values and the aberration rate of them were 8.8% , 10% , and 2.5%, respectively. But there was no significant clinical symptom among the patients. The concentrations of Na^＋ and K^＋ increased significantly but not for Ca^2＋, but all the three were within normal ranges. There was no statistically difference in blood urea nitrogen and serum creatinine, compared to baseline values （P 〉 0.05 ）. Correlation coefficients between hemodilution and APTT, PT were 0.3012 and 0.3407, respectively （ P 〉 0.05 ）. Correlation coefficient between the dose of （ 38.45 ± 4.96 ） ml/kg of the investigational drug and APTT, as well as PT, were 0. 1791 and 0. 1901, respectively. Conclusion large-volume Polyegline infusion does not affect kidney function or electrolyte. But it may have a minor effect on coagulation tests because of hemedilution.