原位肝移植术中应用高渗氯化钠羟乙基淀粉40注射液进行容量治疗的临床研究

Clinical research of capacity treatment by using hypertonic sodium chloride hydroxyethyl starch 40 injection during orthotopic liver transplantation

目的探讨高渗氯化钠羟乙基淀粉40注射液(复方高渗液)应用于原位肝移植术中容量治疗的效果。方法选择2011年3月至2012年1月在广州军区广州总医院收治的15例行经典非转流原位肝移植的患者。肝移植术中当血红蛋白值与术前相差大于20g/L时,即经静脉输注复方高渗液,速度20～30ml/min,给药总剂量不超过500ml。在给药前(T0),给完药后即刻(T1)、10min(T2)、20min(T3)、30min(T4)、60min(T5)共6个时间点,分别测量平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、全心舒张末期容积指数(global end-diastolic volume index,GEDVI)、胸腔内血容积指数(intra thoracic bloodvolume index,ITBI)、血管外肺水指数(extra vascular lungwater index,EVLI)、每搏输出量(stroke volume,SV)、每搏输出量变异度(strokevolumevariation,SVV)。结果与T0比较,T1、T2、T3、T4和T5时间点的MAP明显升高(P<0.05或P<0.01);与T1比较,T3、T4时间点的MAP亦显著升高(P<0.05或P<0.01)。与T0比较,T1、T2、T3时间点的GEDVI、ITBI显著升高(均为P<0.05)。与T0比较,T1时间点的EVLI明显升高(P<0.05)。与T0比较,T1、T2时间点的SV显著升高,而T1～T4时间点的SVV则明显降低(P<0.05或P<0.01)。结果显示,患者用药后血流动力学方面达到了临床容量复苏的效果。结论复方高渗液能迅速使肝移植术中低血容量患者的血压恢复正常,为后续治疗赢得了时间,提高了容量复苏的成功率。

Objective To investigate the effect of capacity treatment by using hypertonic sodium chloride hydroxyethyl starch 40 injection （HSH40） during orthotopic liver transplantation （OLT）. Methods Fifteen patients were selected as objects, who underwent standard OLT from March 2011 to January 2012 in General Hospital of Guangzhou Military Command. When hemoglobin（ Hb） value during OLT differed by 20 g/L or more from pre-operation, HSH40 was immediately transfused by vein with the speed of 20-30 ml/min. The total amount of HSH40 was not over 500 ml. The six different time points were determined including pre- transfusing （T0） , immediately after infusion （T1） , 10 min after infusion （T2） , 20 min after infusion （T3） , 30 min after infusion （T4）, 60 min after infusion （T5）. Several indicators were respectively measured at the6 time points, including mean arterial pressure （MAP）, heart rate （HR）, global end-diastolic volume index （GEDVI）, intrathoracie blood volume index （ITBI）, extravascular lung water index （ EVLI）, stroke volume （SV） , stroke volume variation （SVV）. Results Compared with TO, MAP increased significantly at T1, T2, T3, T4 and T5 （P 〈0. 05 or P 〈0. 01 ）. Compared with T1, MAP also increased significantly at T3 and T4 （ P 〈 0.05 or P 〈 0. 01 ）. Compared with TO, GEDVI and ITBI increased significantly at T1, T2 and T3 （ all in P 〈 0. 05 ）. Compared with TO, EVLI increased significantly at T1 （ P 〈 0. 05 ）. Comparing with TO, SV increased significantly at T1 and T2, but SVV decreased significantly at T1, T2, T3 and T4 （P 〈 0. 05 or P 〈 0. 01 ）. The result showed that the effect of capacity recovery was achieved in hemodynamic indicators after application of HSH40. Conclusions HSH40 can rapidly improve blood pressure of patients with low blood volume to normal level during OLT, save the time for subsequent treatment and increase the success rate of capacity recovery.