高渗氯化钠羟乙基淀粉40注射液对老年手术患者的血流动力学和血管外肺水的观察

The effects of hypertonic saline hydroxyethyl starch 40 on hemodynamics and extravascu Iar lung water in aged patients

目的:总结高渗氯化钠羟乙基淀粉40注射液应用于老年手术患者预扩容的血流动力学和血管外肺水的影响。方法:选择择期手术的老年患者20例,患者以5 ml/(kg·h)的速度静脉滴注高渗氯化钠羟乙基淀粉40注射液250 ml。记录输注前、开始输注后30 min和60 min患者的心率(HR)、平均动脉压(MAP)、心输出量(CO)、心指数(CI)、每搏输出量(SV)、外周血管阻力(SVR)、胸腔内血容量(ITBV)及胸内血管外肺水(EVLW)。结果:患者各时点心率、平均压比较差异无统计学意义。与输注前比较,输注后30 min和输注后60 min的心输出量、心脏指数、每搏输出量升高,外周血管阻力下降(P<0.05)。与输注前比较,输注后30min、输注后60 min胸腔内血容量及胸内血管外肺水比较差异无统计学意义。结论:老年患者术前以适当速率输注适量的高渗氯化钠羟乙基淀粉40注射液,能提高心输出量,降低外周血管阻力,同时也不会增加血管外肺水,保证老年患者预扩容的安全。

Objective To investigate the effects of hypertonic saline hydroxyethyl starch 40 on hemodynamics and extravascuIar lung water in aged patients. Methods Twenty patients（ aged 60-75 years）were enrolled. Hypertonic saline hydroxyethyl starch 40 of 250 ml was given at a rate of 5 ml/（ jg·h）. Heart rate（ HR）,mean arterial pressure（ MAP）,cardiac output（ CO）,stroje volume（ SV）,systemic vascular re-sistance（ SVR）,cardiac index（ CI）,intrathoracic blood volume（ ITBV）and extravascular lung water（ ETLW）were recorded at the beginning of colloid infusion（ baseline value）,30 min and 60 min after infusion. Results There was no apparent change in heart rate（ HR）,mean arterial pressure（MAP）intrathoracic blood volume（ ITBV）and extravascular lung water（ ETLW）. Compared to baseline values,cardiac output （ CO）,stroje volume（ SV）,cardiac index（ CI）increased at 30 and 60 min after colloid infusion,and systemic vascular resistance（ SVR）de-creased significantly（ P〈0. 05 ）. Conclusion Appropriate volume of hypertonic saline hydroxyethyl starch 40 infused at a appropriate rate improves cardiac output,reduces systemic vascular resistance and do not increase intrathoracic blood volume and extravascular lung water.