万汶在重度子痫前期围术期扩容治疗中的应用

Application of Hydroxyethyl starch 130/0.4 in severe pre-eclampsia perioperative expansion

目的：研究第三代人工胶体-中分子低取代级的羟乙基淀粉（万汶）替代白蛋白用于重度子痫前期患者的扩容治疗的有效性及安全性。方法：选择年龄18-45岁，身高145～175cm，体重45～90kg，分娩孕周≥28周，既往无明显内科疾病的重度子痫前期患者共60例。除常规解痉、降压治疗外根据扩容剂的选择将60例患者随即分为万汶组、白蛋白组、空白对照组。对于万汶组及白蛋白纽使用近似剂量的速尿进行利尿治疗。记录患者术前及术后24h、48h、72h、第5天的平均动脉压，口服降压药用量，术后肛门排气时间、水肿消退时间、及平均住院天数，以及出现麻痹性肠梗阻病例数。结果：三组患者的年龄、身高、体重、分娩孕周、术前平均动脉压均元统计学差异，万汶组术后24h及48h内平均动脉压下降较白蛋白组及空白对照组满意，术后降压药拜新同总用量明显低于白蛋白组及空白对照组；三组间的肛门排气时间、水肿消退时间、平均住院天数均有显著性差异，其中万汶组所需时间最短。空白对照组所需时间最长。万汶组无病人出现麻痹性肠梗阻，显著好于另外两组。结论：在速尿的配合下，万汶对用于重度子痈前期围术期的扩容治疗是安全有效的。有利于重度子痫前期患者术后血压的平稳下降、胃肠功能 的恢复、减少降压药的用量及缩短住院时间。

Objective：To investigate the effects and safety of the third-generation of artificial colloids,Hydroxyethyl starch 130/0.4 instead of albumin in the application of severe pre-eclampsia perioperative expansion therapy. Methods：We selected sixty patients with severe pre-eclampsia？ who had no serious diseases aged from 18 to 45 years old,the height between 145- 175cm,weighing from 45 to 90kg and the birth gestational age no less than 28 weeks. In addition to conventional antispasmodic and antihypertensive treatment ,the sixty patients were randomly allocated to the Hydroxyethyl starch 130/0. 4 group,the albumin group and control group according to the choice of expansion agent （liquid）. Diuretic therapy with similar Furosemide dose was used for the first two groups. We recorded the mean arterial pressure before the cesarean section and 24h,48h,72h and 120h after the cesarean section, the doses of oral antihypertensive medicine, time of anal exhaust postoperative and edema subsiding,the average days of hospital stay and the number of cases of paralytic ileus. Results：There was no significant difference in the age, height, weight, birth gestational age and preoperative mean arterial blood pressure in the three groups. The arterial pressure at 24 and 48h after the cesarean section of the Hydroxyethyl starch 130/0.4 group was significantly descended than that of the other two groups. The total amount of oral antihypertensive medicine in the Hydroxyethyl starch 130/0. 4 group was significantly less than that of the other two groups. The time of anal exhaust postoperative, the time of edema subsiding and the average days of hospital stay showed a significant difference among the three groups, with the shortest time in the Hydroxyethyl starch 130/0.4 group and the longest in the control group. There were no cases of paralytic ileus in the Hydroxyethyl starch 130/0.4 group and the condition was much better than that of the other two groups. Conclusion：In cooperation with Furosemide, Hydroxyethyl starch 130/0. 4 applied in severe pre-eclampsia periol〉 erative expansion therapy is proved to be effective and safe, which is beneficial in patients with severe pre- eclampsia after the steady decline in postoperative blood pressure the recovery of gastrointestinal function, the decrease in the dosage of antihypertensive drugs and the shortened hospital stay.