腹部大手术后应用羟乙基淀粉130/0.4液体治疗的临床研究

Application of Hydroxyethyl Starch 130/0.4 on fluid therapy in patients undergoing major abdominal surgery

目的观察腹部大手术后的患者应用羟乙基淀粉130/0.4对术后液体平衡、APACHEⅡ评分及血流动力学的影响。方法选取择期行腹部大手术的患者60例,随机分为晶体液组、羟乙基淀粉(hydroxyethyl starch130/0.4,HES)组各30例,晶体液组予常规晶体液治疗,HES组在常规晶体液治疗的基础上加用羟乙基淀粉130/0.4 500ml qd×3。观察两组患者在术后第1、2、3天尿量、液体平衡量变化;观察两组患者在术后第1、2、3天APACHEⅡ评分、中心静脉压(central venous pressure,CVP)及平均动脉压(mean arterial pressure,MAP)变化。结果两组患者在术后第1、2、3天均存在液体正平衡,且晶体液组液体正平衡量显著高于HES组(P<0.05);术后第2、3天晶体液组患者APACHEⅡ评分明显高于羟乙基淀粉组(P<0.05);术后第1、2天HES组血流动力学指标显著优于晶体液组(P<0.05)。结论腹部大手术后患者存在液体正平衡,术后应用适量的羟乙基淀粉130/0.4能显著减少术后液体正平衡,降低APACHEⅡ评分,并能够改善患者术后血流动力学指标。

Objective To investigate the influence of Hydroxyethyl Starch 130/0.4 on postoperative fluid balance,APACHEⅡ scores and hemodynamics,after major abdominal surgery.Methods 60 patients undergoing elective major abdominal surgeries were selected and divided into two groups,crystalloid group and Hydroxyethyl Starch（HES）group.Patients in crystalloid group were just administrated with crystalloid.In HES group,HES 130/0.4 was administrated with 500ml for consecutive 3 days besides of the use of crystalloid.The changes of fluid balance and hemodynamics,the APACHEⅡ scores were recorded.Results The positive fluid balance of crystalloid group was significantly more than that in HES group on postoperative day 1,2,3（P0.05）.The APACHEⅡ scores of crystalloid group were higher than those in HES group on postoperative day 2,3（P0.05）.The hemodynamics of HES group were significantly better than those in crystalloid group on postoperative day 1,2（P0.05）.Conclusions The positive fluid balance existed after the major abdominal surgery.The positive fluid balance and the APACHEⅡ scores decreased with the application of HES 130/0.4.