高渗氯化钠羟乙基淀粉40注射液应用于急性高容量血液稀释中节约手术用血的效果

Hypertonic sodium chloride hydroxyethyl 40 injection in saving blood transfusion for acute hypervolemic hemodilution

目的观察高渗氯化钠羟乙基淀粉40注射液(HSH溶液)应用于术前急性高容量血液稀释(AHH)中节约手术用血的临床效果。方法选择行颌面整形手术的患者40例,年龄18～30岁,美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级。随机分为A、B、C和D组,每组各10例。所有患者均于切皮前30 min完成AHH。A组予HSH溶液4 mL/kg静脉滴注,B组予6%羟乙基淀粉(130/0.4)15 mL/kg静脉滴注,C组予勃脉力A复方电解质注射液15 mL/kg静脉滴注,D组不予任何液体。术中4组均以勃脉力A复方电解质注射液常规补充液体,维持中心静脉压(CVP)为4 cmH2O(1 cmH2O=0.098 kPa);当患者的红细胞压积(Hct)<0.25时,静脉滴注浓缩红细胞使Hct达到0.25。分别于AHH前(T1)、AHH后即刻(T2)、AHH后30 min(T3)、AHH后1 h(T4)、术毕(T5)5个时间点检测患者的血红蛋白(Hb)水平及Hct,并记录术中出血量、输血量及尿量;于T1、T2、T4、T5时间点检测患者血清K+、Na+、Cl-水平。结果①A、B、C、D组的术中失血量分别为(781.9±77.1)、(748.3±65.7)、(772.8±76.8)和(786.5±88.4)mL,各组间的差异无统计学意义(P值均>0.05),A、B组中无1例输血,C、D组中分别有2、4例患者输血。A、B组的术中尿量分别为(420.5±51.6)、(468.1±44.3)mL,均显著多于D组的(202.5±41.2)mL(P值均<0.05)。②在T2时间点,A、B组的Hb分别为(102.4±12.6)、(99.8±9.5)g/L,Hct分别为0.303±0.017、0.298±0.024,均显著低于D组的(114.5±6.4)g/L、0.341±0.024(P值均<0.05)。③在T2时间点,A、B组的血容量分别扩增(23.30±2.39)%、(24.10±2.58)%,均显著高于D组的(6.06±0.52)%(P值均<0.01)。④在T2时间点,A组的血Na+、Cl-水平分别为(145.8±1.6)、(112.5±2.7)mmol/L,较同组T0时间点的(140.1±1.7)、(99.3±2.8)mmol/L显著升高(P值均<0.01),但仍在正常范围内。结论HSH溶液4 mL/kg用于术前AHH可减少术中出血,有血液保护作用,对电解质平衡无明显影响。

Objective To observe the application of hypertonic sodium chloride hydroxyethyl 40 injection（HSH injection） in saving blood transfusion for acute hypervolemic hemodilution（AHH）.Methods Forty patients,American Society of Anesthesiologists（ASA） classⅠorⅡ,aged 18-30,undergoing maxillary osteotomy were randomly devided into four groups： group A（AHH with HSH injection）,group B（AHH with 6%HES130/0.4）,group C（AHH with Multiple Electrolytes Injection） and group D（no AHH）.AHH was performed within 30 mins before operation.Group A was infused with HSH injection（4 mL/kg）;group B was infused with 6% HES130/0.4（15 mL/kg）;group C was infused Multiple Electrolytes Injection（15 mL/kg）;and group D was not given any liquid.The four groups were all routinely infused with Multiple Electrolytes Injection during operation to central venous pressure（CVP） at 4 cmH2O（1 cmH2O=0.098 kPa）.The patient was given blood transfusion to achieve hematocrit（Hct）=0.25 if Hct〈0.25.Time points were defined as：before AHH（T1）,and at the end of AHH（T2）,30 minites after AHH（T3）,1 hour after AHH（T4）,and at the end of operation（T5）.Venous blood was obtained at T1,T2,T3,T4,and T5 to measure hemoglobin（Hb） and Hct.The volume of blood transfusion,hemorrhage and urine during operation were recorded.Venous blood samples were also obtained at T1,T2,T4,and T5 to mensure Na^＋,K^＋,and Cl^-levels.Results The blood losses during operation were（781.9±77.1）,（748.3±65.7）,（772.8±76.8）,and（786.5±88.4） mL in A,B,C,and D groups,respectively（P0.05）.There was no blood transfusion in group A and B,and two patients in group C and 4 in group D received blood transfusion.The urine volumes of group A and B were（420.5±51.6） and（468.1±44.3） mL,respectively,which were markedly more than that in group D（[202.5±41.2] mL,P〈0.05）.Hct and Hb in group A and B were（102.4±12.6）,（99.8±9.5） g/L and 0.303±0.017,0.298±0.024,respectively,which were significantly lower than those in group D at T2（[114.5±6.4] g/L and 0.341±0.024,P〈0.05）.The expansion of blood volumes in group A and B were（23.30±2.39）% and（24.10±2.58）%,respectively,which was markedly higher than than that in group D（6.06±0.52）% at T2（P0.01）.The Na^＋and Clˉ contents in group A at T2 were（145.8±1.6） and（112.5±2.7） mmol/L,respectively,which were significantly higher than those at T0,respectively（[140.1±1.7],[99.3±2.8] mmol/L,P〈0.01）,but they were all within the normal limit.Conclusion HSH injection（4 mL/kg） for AHH before operation has hematic protective effect.It can also provent the blood,but has no effect on electrolyte balance.（Shanghai Med J,2010,33： 143-146）