胃肠道手术后应用羟乙基淀粉的临床研究

Use of hydroxyethyl starch solution after gastrointestinal surgery

目的:探讨羟乙基淀粉溶液对胃肠道手术患者术后恢复的影响。方法:将2009年1月—12月行胃肠道手术的患者90例,随机分为羟乙基淀粉(HES)组,白蛋白(ALB)组和对照组。术后3 d内,均给予相同能量的静脉营养,另外HES组每日补充羟乙基淀粉(130/0.4)500 mL,ALB组每日补充白蛋白10 g,对照组补充适当晶体液。测定术前和术后第1,4,7天血清白蛋白浓度,C反应蛋白(CRP)水平,并观察术后并发症发生率、住院天数。结果:3组术前临床资料、术前白蛋白水平、手术时间及术中出血量均具有可比性(均P>0.05)。术后第1天,3组间血清白蛋白和CRP水平差异无统计学意义(均P>0.05);术后第4天,对照组血清白蛋白浓度明显低于HES组和ALB组(均P<0.05),而HES组和ALB组血清白蛋白浓度无明显差异(P>0.05)。HES组CRP水平明显低于ALB组和对照组(均P<0.05),而对照组和ALB组血清CRP水平无明显差异(P>0.05);术后第7天,3组间血清白蛋白与CRP水平差异无统计学意义(均P>0.05)。3组并发症发生率差异无统计学意义(P>0.05)。对照组术后住院时间明显长于HES组和ALB组(均P<0.05),而HES组和ALB组间差异无统计学意义(P>0.05)。结论:羟乙基淀粉在胃肠道手术后早期应用可以有效节约白蛋白的用量,控制术后的炎症反应,缩短住院时间。

Objective： To investigate the impact of hydroxyethyl starch （HES） solution therapy on the postoperative recovery of patients after gastrointestinal surgery. Methods： Ninety patients scheduled to undergo gastrointestinal surgery in our hospital during.January 2009 to December 2009 were randomly divided into the HES group, albumin （ALB） group and control group. All the patients received parenteral nutrition at the same energy intake within the first 3 days after surgery. In addition, the HES group was supplied with hydroxyethyl starch （500 mL） daily, and the ALB group was supplemented with albumin （10 g） daily, while the control group was given adequate amount of crystalloid solution.The serum albumin concentration and C-reactive protein （CRP） level were measured before surgery and on POD 1, 4 and 7, and the incidence of postoperative complications and length of postoperative hospital stay were also observed. Results： The preoperative clinical data, preoperative albumin level, operative time and intraoperative blood loss of the 3 groups were comparable （P〉0.05）. On POD 1, the serum albumin concentrations and CRP levels had no significant differences among the 3 groups （all P〉0.05）; on POD 4, the serum albumin level of control group was significantly lower than that of HES and ALB group （both P〈0.05）, but no difference was noted between the HES and ALB group （P〉0.05）. The CRP level of HES group was significantly lower than that of control and albumin group （both P〈0.05）, but no difference was found between the control and ALB group （P〉0.05）; on POD 7, the serum albumin concentrations and CRP levels of the 3 groups had no obvious differences （all P〉0.05）. The incidence of postoperative complications of the 3 groups had no statistical difference （P〉0.05）. The length of postoperative hospital stay of control group was significantly longer than that of liES and ALB group （both P〈0.05）. Conclusion： HES solution supplement in the early postoperative period of gastrointestinal surgery can effectively reduce the use of albumin, control postoperative inflammatory response, and shorten the length of postoperative hospital stay.