高渗氯化钠羟乙基淀粉40注射液对经尿道前列腺电切术患者血液动力学和电解质的影响

The Effects of Hypertonic Saline Hydroxyethyl Starch 40 on Hemodynamics and Electrolytes in Patients Undergoing Transurethral Resection of Prostate

目的:探讨高渗氯化钠羟乙基淀粉40注射液对经尿道前列腺电切术(TURP)患者血液动力学参数和电解质的影响。方法:择期TURP中老年患者30例,于L3-4行蛛网膜下腔麻醉,麻醉开始前以4-5mL/kg-1.h-1输入高渗氯化钠羟乙基淀粉40注射液。比较输注前、输注后30min和输注后60min的心率、血压、无创心排监测数据和血浆电解质浓度等变化。结果:患者各时点心率、血压比较无统计学意义。与输注前比较,输注后30min和输注后60 min的心输出量、每搏输出量升高,外周血管阻力下降(P<0.05)。输注后60min的心脏指数高于输注前(P<0.05)。射血前期、左室射血时间、收缩时间比率各时点比较无统计学意义。与输注前比较,输注后30minNa+浓度略升高(约2%)(P<0.05),而输注后60min无统计学差异(P>0.05)。各时点K+和Ca2+浓度比较无统计学意义。结论:TURP术中以适当速率输注适量的高渗氯化钠羟乙基淀粉40注射液,能提高心输出量,降低外周血管阻力,内环境稳定。

Objective： To investigate the effects of hypertonic saline hydroxyethyl starch 40 on hemodynamics and electrolytes in patients undergoing transurethral resection of prostate（TURP）.Method： Thirty patients（aged 55-80） scheduled for TURP were enrolled.Hypertonic saline hydroxyethyl starch 40 was given at a rate of 4-5mL/kg-1.h-1 before anesthesia and spinal anesthesia was performed at the L3-4 interspace.Hemodynamic changes were measured using impedance cardiography monitor.Heart rate,blood pressure,cardiac output（CO）,stroke volume（SV）,systemic vascular resistance（SVR）,cardiac index（CI） and electrolyte concentrations were recorded at the beginning of colloid infusion（baseline）,30minutes and 60 minutes after infusion.Result： There was no apparent changes in heart rate,blood pressure,K＋ and Ca2＋ throughout the observation.Compared to base values,CO and SV at 30minutes and 60 minutes after colloid infusion increased,and SVR decreased significantly（P 0.05）.CI at 60 minutes after infusion was higher than base value（P 0.05）;Na＋ increased by approximately 2% at 30 minutes after infusion（P 0.05）,but no any significant difference showed at 60 minutes after infusion（P0.05）.Conclusion： Appropriate volume of hypertonic saline hydroxyethyl starch 40 infused at an appropriate rate improves cardiac output,reduces systemic vascular resistance during TURP.