胶体液对肝移植围术期血浆胶体渗透压的影响

The effect of plasma colloid osmotic pressure by colloid liquid undergoing liver transplantation

目的观察经典非转流原位肝移植术中应用4％白蛋白和6％羟乙基淀粉130／0．4氯化钠（万汶）注射液对血浆胶体渗透压的影响。方法选取术前血浆白蛋白含量正常的经典非转流原位肝移植患者20例，随机分为两组。白蛋白组（Ⅰ组）和方汶组（Ⅱ组）。分别于建立肘正中静脉通路前（T0）、开始榆注30min（T1）、输注60min（T2）、输注结束后30min（T3）、输注结束后6min（T4）。取静脉血进行胶体渗透压测定，同时测定血浆白蛋白含量。结果血浆胶体渗透压Ⅰ组于T1开始下降（P〈0．05），于T2恢复至术前水平，与T1比较有差别（P〈0．05）。Ⅱ组于T2时明显升高（P〈0．05），两组间在T1时有差别（P〈0．05），T2时差别明显（P〈0．01）。血浆白蛋白含量Ⅰ组在T1时升高明显（P〈0．05），Ⅱ组在T2时与T1比较有降低趋势（P〈0．05），与T0比较有差异（P〈0．05），两组间在T1时有差异（P〈0．05），到T2、T3、T4时差异更明显（P〈0．01）。结论本研究术中胶体液仅输注4％白蛋白液组短期有降低血浆胶体渗透压的趋势，长时间输注可维持血浆胶体渗透压在正常水平。胶体液仅输注万汶组可提高术中血浆胶体渗透压。

Objective To observe the influences of plasma colloid osmotic pressure after infusing 4% human serum albumin or hydroxyethyl starch 130/0.4 sodium chloride injection（6%） during standard orthotopic liver transplantation（SOLT）without anhepatic veno-venous bypass. Methods Selected 20 patients without hypoproteinemia were randomly allocated to receiving intravenous infusion of 4% human serum albumin（Ⅰ） and hydroxyethyl starch 130/0.4 sodium chloride injection（6%）（Ⅱ）, were performed under general anesthesia. Plasma colloid osmotic pressure and plasma albumin protein level were measured before puncting ulnar vein（T0）, when infusing 30 min （T1）, infusing 60min（T2）,after infusing 30min（T3） and after infusing 60min（T4）. Results The transfuse volume dose was （4239 ±615） ml in group Ⅰ and was （4340 ±586） ml in group If. In group Ⅰ the plasma colloid osmotic pressure was descended at （T1） （Y〈0.05）,and recovered at （T2） ,was higher than （T1） （P〈0. 05）.In group Ⅱ the plasma colloid osmotic pressure was stepped up at （T2） （P〈0.05）. And was different at （T1） （P〈0.05）and （T2） （P〈0.01） between two group. The plasma albumin protein level was stepped up at （T1） （P〈0.05） in group Ⅰ.Compared with （T2） and （TO） the plasma albumin protein level was lower （P〈0.05） at （T2） in group Ⅱ. And was different at （T1） （P〈0.05） and （T2, T3,T4 （P〈0.01） between two group. Conclusion The plasma colloid osmotic pressure is descend in short time and recover soon , maintain in normal for a long time when infusing 4% human serum albumin except infusing other blood products. Infuse 4% human serum albumin can maintain the plasma albumin protein level in normal ,but can＇t raise the level, lnfuse the hydroxyethyl starch 130/0.4 sodium chloride injection（6%） can raise the plasma colloid osmotic pressure and cut down the plasma albumin protein level except infusing other blood products.