高渗氯化钠羟乙基淀粉40注射液预扩容对母婴血浆胶体渗透压的影响

Effects of hypertonic sodium chloride hydroxyethyl starch 40 injection on plasma colloid osmotic pressure during cesarean section

目的观察高渗氯化钠羟乙基淀粉40注射液(HSH40)预扩容对母婴血浆胶体渗透压(COP)的影响。方法选择择期行剖宫产术的产妇80例,随机分为两组,每组40例。HSH40组预先静脉滴注HSH404mL/kg,平衡液组预先静脉滴注乳酸钠林格注射液4mL/kg。监测并记录入手术室时(T0)、预充量静脉滴注完即刻(T1)、预充量静脉滴注后30min(T2)、胎儿娩出时(T3)、术毕(T4)的心率和血压,并采集各时间点产妇的静脉血及胎儿娩出尚未建立呼吸时的脐动、静脉血检测血浆COP。结果两组产妇的年龄、体重、麻醉诱导至胎儿娩出时间、子宫切开至胎儿娩出时间和手术时间的差异均无统计学意义(P值均>0.05)。与平衡液组同时间点比较,HSH40组在T1、T2、T3时间点的血浆COP水平均显著升高(P值均<0.05);与同组T0时间点比较,两组在T2、T3、T4时间点的血浆COP水平均显著降低(P值均<0.05);两组间脐动、静脉血血浆COP水平的差异均无统计学意义(P值均>0.05)。HSH40组产妇的低血压发生率为12.5%显著低于平衡液组的27.5%(P<0.05)。两组间新生儿出生后1和5minApgar评分的差异均无统计学意义(P值均>0.05)。结论 HSH40预扩容有利于维持产妇术中血浆COP和血流动力学的稳定,且对胎儿血浆COP无影响。

Objective To observe the preloading effects of hypertonic sodium chloride hydroxyethyl starch 40 injection（HSH40） on plasma colloid osmotic pressure（COP） during cesarean section.Methods Eighty patients scheduled for cesarean section under spinal-epidural anesthesia were randomly divided into two groups（n=40）.HSH40（4 mL/kg,group H） or Ringer solution（4 mL/kg,group L） was injected for preloading.Blood samples were taken to measure the levels of COP and hemodynamic parameters（heart rate and blood pressure） before infusion（T0）,at the end of infusion（T1） and 30 mins after infusion（T2）,at delivery of baby（T3） and the end of operation（T4）.Umbilical venous and arterial blood samples were also obtained immediately after delivery for determination of COP.Results There were no significant differences in terms of maternal age,body weight,duration from anesthesia induction to fetal disengagement,duration from uterus-cut to fetal disengagement,or operation time between the two groups（all P0.05）,neither were the COP levels of umbilical venous and arterial blood between two groups immediately after delivery（all P0.05）.However,COP levels at T1,T2 and T3 in group H were significantly higher than those in group L（all P0.05）.Compared with that at T0,COP significantly decreased at T2,T3 and T4 in each group（all P0.05）.The incidence of hypotension in group H（5 cases,12.5%） was significantly lower than that in group L（11 cases,27.5%,P0.05）.There were no significant differences in one-minute and five-minute Apgar scores between the two groups（all P0.05）.Conclusion HSH40 for preloading can keep maternal COP and hemodynamic parameters stable,and does not affect fetal COP.（Shanghai Med J,2012,35：825-828）