高渗氯化钠羟乙基淀粉40注射液在急性颅脑损伤伴失血性休克患者手术中的应用

The Clinical Appfication and Observation of Hypertonic Sodium Chloride Hydroxyethyl Starch-40 Injection in Acute Head Mjury Complicated by Hemorrhagic Shock Operation Patiens

目的探讨高渗氯化钠羟乙基淀粉40注射液(以下简称高渗盐复合液)对急性颅脑损伤伴失血性休克手术患者的血液动力学,肝、肾、凝血功能、电解质和尿量的影响。方法急性颅脑损伤手术伴失血性休克患者25例,均采用静吸复合麻醉,手术开始前输入高渗盐复合液250 mL,输注速度10 mL/(kg.h)-1。检测输注前、输注后24 h的肝、肾、凝血功能,并在输注前、输注后30、60、120 min、24 h,抽取动脉血进行血气分析。记录Na+、K+、CL-、HCT。观察并记录输注前、输注毕、输注后30、60、120 min、术毕SBP、DBP、MAP、HR。输注前放空尿袋,观察并记录输注后30 min、60 min、120 min、术毕尿量。结果输注毕、输注后30、60 min血压明显升高(P<0.05);在输注后各个时间点心率明显下降(P<0.05),尿量明显增加。血气分析检测电解质和HCT的结果,血清Na+在输注后30、60 min明显升高(P<0.05);在输注后120 min稍有下降,在输注后24 h恢复至正常水平,与输注前比较无显著性差异,K+、C1-24 h恢复到正常,且与给药前比较无显著性差异。HCT24 h未恢复到正常,且与给药前比较有显著性差异。肝功能、肾功能及凝血功能检测其输注前及输注24 h的结果,除TBIL、DBIL和APTT检测结果有差异外,其他几项2个时间点的结果均无显著性差异。结论高渗盐复合液可安全有效地应用于急性颅脑损伤伴失血性休克手术患者,在升高血压、维持血液动力学稳定的同时,可提供一种有效地扩充血容量液体。

Objective To approach the effects of Hypertonic Sodium Chloride Hydroxyethyl Starch- 40 Injection （HSH） on hemodynamics, Liver function, renal function, coagulation function,electrolyte, urine volume of acute head injury complicated by hemorrhagic shock operation patients. Methods Before the operation, 25 cases of acute head injury complicated by hemorrhagic shock patients were infused in HSH respectively. HSH 250mL was infused in a rate of 10 mL/h, ALL of them were carried with intravous combined inhaled anesthesia. Arterial blood samples were taken before injection and at 30,60,120 minutes,24 h after injection. The blood pressure,heart rate, Liver function, renal function, coagulation function, electrolyte and urine volume were compared before injection with at the very time 30,60,120 minutes,24 h after the Injection. Results Blood pressure rised and HR decreased obviously at 30, 60 minutes after the injection （ P 〈 0.05） ; Na^ ＋ level increased significantly 30,60 minutes after the injection （ P 〈0.05）Na^＋、K^＋ 、Cl^- normal level at 24 h after the injection. HCT decreased obviously at 24 h after the injection （ P 〈 0.05）. The urine volume increased obviously at every time after the injection（ P 〈 0.05）. Liver function, renal function, coagulation function did not altered obviously at 24 h after the injection. Conclusion HSH could be used safely and effectively on the operation patients of acute head injury complicated by hemorrhagic shock. It could in crease blood pressure and maintain the stability of haemodynaamies, It could provide effective volume therapy fluid to patients with acute head injury complicated by hemorrhagic shock.