术前小剂量HSS40对肝部分切除术患者术中血流动力学和氧代谢的影响

The effect of pre-operative small-dose HSS40 on hemodynamics and oxygen metabolism in patients undergoing partial hepatectomy

目的探讨肝部分切除术小剂量高渗氯化钠羟乙基淀粉40注射液(HSS40)对患者术中血流动力学和氧代谢的影响。方法将择期行肝部分切除术患者45例随机分成研究组(22例)和对照组(23例)。研究组术前输注HSS40,对照组术前输注乳酸林格氏液(RL,R),监测两组不同时间点血流动力学和氧代谢指标。结果与对照组比较,研究组术中输液量及输血量较少(P<0.05);心输出量(CO)、心脏指数(CI)在预扩容后上升(P<0.05),且明显高于对照组(P<0.05);体循环阻力指数(SVRI)和肺循环阻力指数(PVRI)在稀释后下降(P<0.05),也低于对照组(P<0.05);研究组扩容后pH值、动脉血氧饱和度(SaO2)、氧供(DO2)和氧耗(VO2)无变化(P>0.05);P(a-v)O2值T1～T6时明显增加(P<0.01),血细胞比容(HCT)下降。结论术前小剂量HSS40对肝部分切除术患者术中血流动力学更稳定,内环境稳定,可增加组织血流灌注,减少术中血液丢失,减少库血的使用,改善肝细胞缺血再灌注损伤。

Objective To evaluate the effect of small-dose hypertonic sodium chloride solution hydroxy- ethyl starch 40 injection （HSS40） on hemodynamics and oxygen metabolism in patients undergoing partial hepatectomy. Methods 45 patients receiving selective partial hepatectomy were randomly divided into a study group （ n =22） and a control group （ n =23）. The study group were given pre--operative infusion of HSS40, the control group were given Ringer＇s lactated solutions （RL, R）. The hemodynamics and oxygen metabolism indexes were monitored at different time points. Results Compared with control group, less infusion volume and blood transfusion volume were administered to the study group in operation （ P〈0.05）. In study group, cardiac output （CO） and cardiac index （CI） elevated after volume expansion （ P〈0.05）, and also higher than those in the control group, there were statistically significant differences（ P〈0.05）; systemic vascular resistance index（SVRI） and pulmonary vascular resistance index（PVRI） decreased after dilution （ P 0.05）, and also was statistically lower than control group （ P〈0.05） ; after volume expansion, SaO2, DO2 and VO2 in study group remained the same （ P 〈0.05） ~ value P（a--v）O2 at time points TI^T6 was statisti- cally significant increased （ P〈0.01）, hematocrit （HCT） decreased. Conclusion Pre--operative small-- dose HSS40 could help patients with partial hepatectomy have more stable hemodynamics and stable inner environment, could enhance tissue hemoperfusion, could reduce blood loss, could decrease bank blood use, and could relieve hepatocytes ischemia--reperfusion injury.