6%羟乙基淀粉130/0.4用于婴儿腹部大手术的研究

Six percent hydroxyethyl starch 130/0.4 in neonates and infants undergoing major abdominal surgery

目的评价6%羟乙基淀粉130/0.4用于婴儿腹部大手术术中容量治疗安全性和有效性。方法行腹部大手术,术中应用6%羟乙基淀粉130/0.4的25例婴儿（0-12个月龄,体重1.9-9.5kg）为试验组;选择性别、月龄、体重、手术及手术时间与试验组相匹配,术中未使用6%羟乙基淀粉130/0.4的25例婴儿作为对照组。两组患儿所行手术操作由同一组外科医师完成,术中容量治疗策略及使用血液制品的指征和用量,均由麻醉主治医师根据临床情况综合确定。分析试验组和对照组患儿术中输注液体的差异,比较两组患儿手术前后血液动力学的变化,比较两组患儿术中使用血液制品的比例。结果两组患儿月龄、性别、体重、手术时间和术前血红蛋白含量等一般情况差异无统计学意义。试验组术中应用胶体液量（85.00±41.00）ml显著高于对照组（24.00±35.47）ml,P=0.000;而晶体液量（163.00±101.15）ml显著少于对照组（225.00±114.31）ml,P〈0.05。试验组患儿术前心率（129.16±22.01）次/min显著低于对照组（143.88±16.88）次/min,P〈0.05,而两组患儿术后心率和手术前后收缩压、舒张压、平均动脉压差异均无统计学意义。试验组有7例（28%）患儿,而对照组有14例（56%）患儿术中使用血液制品,差异有统计学意义,P〈0.05。试验组患儿未见6%羟乙基淀粉130/0.4相关的不良反应或外科并发症。结论6%羟乙基淀粉130/0.4可安全用于行腹部大手术婴儿术中体液容量治疗,并减少术中使用血液制品患儿的比例。

Objective To evaluate the safety and efficacy of 6% hydroxyethyl starch 130/0. 4 in volume therapy in neonates and infants undergoing major abdominal surgery. Methods Twenty-five cases of neonates and infants undergoing major abdominal surgery, which had been administered 6% hydroxyethyl starch 130/0. 4 for volume therapy during operations ,were enrolled into test group. Another well matched 25 cases of neonates and infants,undergoing the same surgeries as the test group,who had not been infused 6% hydroxyethyl starch 130/0. 4 during the operations,were grouped into control group. In both groups ,it was the attending anesthesiologist to decide the volume therapy strategy and to determine the transfusion criteria. All of the procedures but 1 case in each group were performed under general anesthesia combined with epidural or caudal blockade. The hemodynamic variables, the crystaUoid, colloid and blood products volumes, as well as the percentage of patients needs transfusion during operations were compared between the groups. Results The basic heart rate in the test group was significantly slower than that in the control group,P 〈0. 05 ,and no significant difference in the other hemodynamic variables was founded between the groups. The colloid volume in the test group was significantly more than, while the crystalloid volume was significantly less than that in the control group. Seven cases （ 28% ） in the test group, significantly less than 14 cases （ 56% ） in the control group ,used blood products during the operations ,P 〈 0.05. No 6% hydroxyethyl starch 130/0. 4 related adverse effects or surgical complications were noted in the test group. Conclusions Six percent hydroxyethyl starch 130/0. 4 can be used safely and efficiently for volume replacement in neonates and infants undergoing major abdominal surgery, and with a strict criteria for transfusion, may decrease the percentage of the patients who need blood products during the operations.