琥珀酰明胶和羟乙基淀粉血液稀释对肿瘤患者血清电解质和血浆组胺的影响

The effect of hemodilution with succinylated gelatin and 6% HES 130/0.4 on serum electrolytes and plasma histamine in cancer patients

目的观察4%琥珀酰明胶（succinylated gelatin）和6%羟乙基淀粉130/0.4（hydroxyethyl starch,6%HES130/0.4）行急性高容量血液稀释（acute hypervolemic hemodilution,AHH）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组输注琥珀酰明胶15ml/kg;H组输注6%HES130/0.415ml/kg。两组患者麻醉诱导后10min开始行AHH,分别在AHH前（T0）,开始AHH后5min（T1）,开始AHH后30min（T2）,完成AHH后30min（T3）,完成AHH后1h（T4）,完成AHH后3h（T5）分别采集静脉血,检测红细胞比容（Hct）和血清电解质Na＋、K＋、Ca＋、Cl-的变化及血浆组胺的变化。结果（1）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差异无统计学意义;组内比较G、H两组Na＋、Cl-、K＋、Ca＋值在T1～T5时间点与T0时间点比较差异有统计学意义。（2）血浆组胺的变化：组间比较各时间点组胺值G、H两组比较差异无统计学意义;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。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 effect of acute hypervolemic hemodilution（AHH） with Gelofusine and 6%HES130/0.4 on serum with electrolytes and plasma histamine of cancer patients.Methods Sixty cancer patients of elective surgery esophageal cancer or colon cancer were randomly divided into two groups with 30 in each group.Group G received infusion of succinylated gelatin 15ml/kg;Group H received infusion of 6% HES 130/0.4 15 ml /kg.After induced anesthesia for 10 minutes,AHH were started in tow groups,venous blood samples before AHH（T0）,5min after beginnig AHH（T1）,30 min after beginnig AHH（T2）,30 min after finishing AHH（T3）,1hour after finishing AHH（T4）,3 hours after finishing AHH（T5）were collected for determining Hct,serum electrolyte Na＋,K＋,Ca＋,Cl-and plasma histamine.Results（1）In inter-group comparision on serum electrolyte：at T0 to T5 there were not significant differences between group G and H.In intra-group comparision there was rise trend of Na＋ and Cl-.In intra-group comparision on serum electrolyte,at T0 and T1 to T5 there were significantly differences compareed with that at T0 in two groups（P〈0.05）,and K＋ and Ca＋ decrease significantly（P〈0.05）.（2）In inter-group comparision on histamine：at T0 to T5 there were not significant differences between group G and H.In intra-group comparision on histamine：in group G and H,the histamine at T1 to T5 were significantly higher than that at T0（P〈0.05）.Conclusion Succinylated gelatin and hydroxyethyl starch in the implementation of mild AHH,have a certain influence upon serum electrolyte,however,no clinical symptoms,plasma histamine can slightly increased,but still within the normal range,do not cause symptoms.So they are safe in application of AHH.