琥珀酰明胶与羟乙基淀粉血液稀释对患者血清电解质和血浆组胺的影响

Effects of succinylated gelatin and 6%HES130/0.4 hemodilution on serum electrolytes and plasma histamine

目的观察4％琥珀酰明胶和6％羟乙基淀粉130／0．4行急性高容血液稀释对患者血清电解质及血浆组胺的影响。方法选择食管癌、结肠癌择期手术60例，随机分为G、H两组（n=30）。G组输注4％琥珀酰明胶15ml／kg；H组输注6％羟乙基淀粉130／0．415ml／kg。两组患者麻醉诱导后10min开始行急性高容量血液稀释（acute hypervolemic hemodilution，AHH），分别在AHH前（R）、开始AHH后5min（T1）、开始AHH后30min（T2）、完成AHH后30min（L）、完成AHH后1h（T4）、完成AHH后3h（L）分别采集静脉血，检测静脉血检测Hct和血清电解质Na^＋、K^＋、Ca^2＋、Cl^-的变化及血浆组胺的变化。结果血清电解质的变化：组间比较，Na^＋、K^＋、Ca^＋、Cl^-值在各时间点两组间比较无统计学差异；组内比较：G、H两组Na^＋、Cl^-、K^＋、Ca^2＋值在T1～T5时间点与T0时间点比较有统计学差异（P〈0．05）。血浆组胺的变化：组间比较，各时间点组胺值G、H两组比较无统计学差异；组内比较，组胺值与T0比较其余各时间点差异有统计学意义（P〈0．05）.结论用琥珀酰明胶和羟乙基淀粉实施轻度AHH时对血清电解质有一定的影响，但没有明显临床症状，仍可安全应用；两组均可引起血浆组胺轻度升高，但在正常值范围，不引起临床症状。

Objective To investigate the effects of acute hypervolemic hemodilution （AHH）using 4% succinylated gelatin and hydroxyethyl starch on serum electrolyte and plasma histamine. Methods Sixty patients suffered from esophageal carcinoma or colon carcinoma were randomized into 2 groups （n=30）receiving intravenously 15 ml/kg of succinylated gelatin （group G）or 6% HES 130/0.4 （group H）. AHH was conducted 10 min after anesthesia induction. Levels of Hct, serum electrolyte and plasma histamine were measured before AHH, 5 min（%）, 30 min（T2） of AHH, 30 min （T3）, 1 h （T4） and 3 h after AHH termination, respectively, AHH（T5）. Results The levels of serum Na^＋, K^＋, Ca^2＋, Cl^- and plasma histamine at T1, T2, T3 and T4 were significantly lower and higher respectively than those at T0, with no statistical difference between two groups at each same time-point. Conclusion AHH using succinylated gelatin or hydroxyethyl starch is safe although bringing slight change in serum electrolytes and plasma histamine levels.