羟乙基淀粉130／0．4用于体外循环心脏外科手术患者的安全性

Safety of volume replacement with HES 130/0.4 in cardiac surgery with cardiopulmonary bypass

目的评价6％羟乙基淀粉130／0．4（6％HES130／0．4）用于体外循环心脏外科手术患者的安全性。方法拟在体外循环下行心脏外科手术患者60例，年龄18～64岁，ASAⅡ或Ⅲ级，随机分为2组（n=30）：HES组和4%琥珀酰明胶组（GEL组）。术中HES组和GEL组分别静脉输注6％HES13010．4和4％琥珀酰明胶7～2ml·kg·h^-1维持中心静脉压6～12mmmHg和／或肺动脉楔压8～1．5mmHg体外循环颅充流包括胶体液500～1000ml.ICU中HES组和CEL组分别静脉输注6%HES130／0．4和4％琥珀酰明胶60～120ml／h．维持中心静脉压6～12mmHg和，或肺功脉楔压8～15mm·Hg。记录围术期血液动力学指标、红细胞压积、凝血功能指标，肝、肾功能指标、液体出入量及不良反应的发生情况。结果两种胶体围术期平均用量都接近50ml．kg·h^-1。2组血液动力学、红细胞压积、凝血功能指标、肝、肾功能指标、液体出入量和不良反应发生率差异无统计学意义（P〉0．05）、结论围术期超大剂量6％HES130／0．4（50ml·kg^-1·d^-1）可安全地用于体外循环心脏外科手术患者。

Objective To evaluate the safety, of volume replacement with 6% hydroxyethyl starch （HES） 130/0.4 in cardiac surgery with cardiopulmonary bypass （CPB）. Methods Sixty ASA Ⅱ orⅢ patients aged 18-64 yr undergoing cardiac surgery with CPB were xandomly divided into 2 groups （ n = 30 each） ： group I 6% HES 130/0.4 （HES） and group Ⅱ 4 % succimyl gelatin （GEL）. Priming solutions contained 6 % HES 130/0.4 or 4 % suceinyl gelatin 500-1 000 ml. 6% HES 130/0.4 and 4% succinyl gelatin were infused at 60-120 ml/h during operation to maintain CVP at 6-12 mm Hg and/or PCWP at 8-15 nun Hg in group HES and GEL respectively. Hemodynamic parameters, Hct, blood coagulation were measured before, during and after operation. Hepato-renal function was measured before and after operation. Fluid balance and adverse reactions were recorded. Results The average amount of colloid approached 50 ml· kg^-1·d^- 1 in both groups. There were no significant differences in hemodynamics, Hct, blood coagulation parameters and hepato-renal function, fluid balance and adverse reactions between the two groups. Conclusion 6% HES 130/0.4 can be safely used for plasma volume replacement in cardiac surgery, with CPB if the amount is less than 50 ml· kg^-1·d^- 1.