高渗氯化钠羟乙基淀粉在创伤失血性休克手术中的应用与护理

Clinical effects and nursing of hyperosmotic sodium chloride hydroxyethyl starch in treating the traumatic hemorrhagic shock

目的研究高渗氯化钠羟乙基淀粉用于创伤失血性休克患者的有效性和安全性。方法选取创伤失血性休克患者40例,随机分为高渗氯化钠羟乙基淀粉组和复方氯化钠组,每组20例。两组患者均采用吸入麻醉,诱导时依次静脉注射芬太尼2～4μg/kg、阿曲库铵0.5～0.6mg/kg、依托咪酯0.3～0.4mg/kg,气管插管后行机械控制呼吸,麻醉维持吸入2%～4%七氟醚,深度维持脑电双频谱指数50～60。手术前HS组输入高渗氯化钠羟乙基淀粉400～500mL;LRS组常规输入等量复方氯化钠。记录液体输注前及麻醉后MAP、HR变化。于输液前、输液后30min抽取静脉血检测电解质。结果给药后HS组MAP逐渐升高,HR逐渐减慢,15、30、60min时间点MAP明显高于给药前和LRS组,差异有统计学意义(P<0.05)。HR慢于给药前和LRS组,差异有统计学意义(P<0.05)。HS组Na+、Cl-高于输液前和LRS组,差异有统计学意义(P<0.05)。结论高渗氯化钠羟乙基淀粉可以有效、安全地用于创伤失血性休克患者,护理的关键是密切观察循环系统的变化,以及预防羟乙基淀粉快速输入可能引起的变态反应。

Objective To investigate the clinical effects and safety of hyperosmotic sodium chloride hydroxyethyl starch in treating the traumatic hemorrhagic shock. Methods 40 cases of traumatic hemorrhagic shock were divided into two group by random principle. One was group of hyperosmotic sodium chloride hydroxyethyl starch, and the other was group of compound sodium chloride. And each group has 20 cases. The cases were taken by inhalation anesthesia induced by fentany of 2 ～ 4 μg/kg and atracurium of 0.5 ～ 0.6 mg/kg and etomidate of 0.3 ～ 0.4 mg/kg. The HS were injected 400~500 mL of hyperosmotic sodium chloride hydroxyethyl starch preoperation while the LRS were injected the same amount of compound sodium chloride.The change of MAP and HR were recorded before injection and after anesthesia.All cases were tested electrolyte pre- and after injection. Results After injection, the MAP increased and the HR decreased slowly in the HS group. And the MAP increased more than the LRS group （P 0.05） while the HR is less than the LRS group （P 0.05）. Na ＋ and Cl - of HS group were higher than before infusion and LRS group（P 0.05）. Conclusion The hyperosmotic sodium chloride hydroxyethyl starch can be used effective and safety in treating the traumatic hemorrhagic shock. The key nursing is observing the change of circulation and preventing the allergic reaction evoking by quickly injecting the hydroxyethyl starch.