高渗氯化钠羟乙基淀粉40成人腰-硬联合麻醉的应用

An open-label,randomized and multicenter study on clinical assessment of hypertonic sodium chloride hydroxylethyl starch 40 in adult patients undergoing combined spinal-epidural anesthesia

目的观察高渗氯化钠羟乙基淀粉40(HSH)预防妇科下腹部手术腰-硬联合麻醉(CSEA)低血压的效果及其对生理功能的影响。方法选择10个研究中心行妇科下腹部手术CSEA麻醉患者480例,随机分为四组:Ⅰ组HSH4ml/kg,Ⅱ组HSH6ml/kg,Ⅲ组6%羟乙基淀粉130/0.4(HES130/0.4)7ml/kg,Ⅳ组复方氯化钠10ml/kg,均于麻醉前输注上述液体。记录液体输注前及麻醉后BP、HR变化。同时抽取对侧肢体静脉血检测电解质、Hb、Hct及凝血功能。结果Ⅳ组麻醉后BP显著低于麻醉前及其他三组(P<0.05)。与麻醉前比较,Ⅰ、Ⅱ组电解质变化显著(P<0.05),Ⅰ、Ⅱ、Ⅲ组Hb及Hct均显著下降(P<0.05),Ⅱ、Ⅲ组凝血时间延长(P<0.05)。结论预注HSH可有效预防CSEA引起的低血压,但对电解质、凝血功能、Hb及Hct产生一定影响。

Objective To observe the efficacy of hypertonic sodium chloride hydroxyethyl starch 40 （HSH） in gynecological patients undergoing combined spinal-epidural anesthesia（CSEA）. Methods A total of 480 patients scheduled for selective gynecological operations under CSEA in ten medical centers were randomized into four groups of Ⅰ（HSH 4 ml/kg） ,Ⅱ（HSH 6 ml/kg）, Ⅲ（6% hydroxyethyl starch 130/0.4 7 ml/kg） ,and Ⅳ（Ringer＇s solution 10 ml/kg）. All fluids were infused brfore （;SEA. Blood pressure（BP） was recorded before fluid infusion and after CSEA. Blood samples were taken from contralateral vein for measuring electrolytea,bemoglobin（Hb） ,hematocrit（Hct） and coagulation. Results BP after anesthesia was significantly lower in group 1g than that baseline and the other three groups（P〈0. 05）. Compared to before, electrolytes were changed markedly in groups of I and Ⅱ（P〈0. 05）, Hb and Hct were decreased in groups of Ⅰ,Ⅱ and Ⅲ（P〈0. 05）, and APTT was prolonged in groups of Ⅱand Ⅲ （P〈0. 05）. Conclusion Preloading HSH can effectively prevent the occurrence of hypotension induced by CSEA, but has a certain influence on dectrolytes, Hb, Hct and blood coagulation.