6%羟乙基淀粉130/4.0注射液联合呋塞米注射液治疗围生期重度子前期并发腹腔积液55例

6% Hydroxyethyl Starch 130 /4.0 Injection Combined with Furosemide Injection in Treatment of 55 Cases of Severe Preeclampsia Complicated by Ascites

目的观察围生期不同液体治疗重度子前期并发腹腔积液的临床效果,寻找较好的液体管理方式。方法分析2010年1月~2012年12月南方医科大学附属深圳市妇幼保健院入院确诊的围生期重度子前期并发腹腔积液患者。治疗组55例,围生期使用6%羟乙基淀粉130/4.0注射液和呋塞米注射液静脉微泵滴注治疗;对照组52例,围生期使用5%人血清蛋白加呋塞米静脉微泵滴注治疗。观察两组患者生命体征、胶体渗透压、血液黏稠度等的变化情况,并对比两组肺水肿等并发症的发生率。结果治疗组剖宫产术后24 h血压显著低于对照组,而心率和血氧饱和度比较显著高于对照组（均P〈0.05）;对照组术后肺水肿发生率17.3%,而治疗组无一例出现肺水肿;治疗组术后第5天红细胞压积和24 h尿蛋白显著低于对照组,胶体渗透压显著高于对照组（均P〈0.05）;而术后第5天两组血浆清蛋白比较,差异无统计学意义（P〉0.05）;治疗组水肿完全消退的时间显著少于对照组[（2.43±0.37）d比（3.74±0.59）d,P〈0.01]。结论重度子前期并发腹腔积液围生期患者使用6%羟乙基淀粉130/4.0注射液加呋塞米注射液静脉微泵滴注治疗可以有效提高胶体渗透压,并改善水肿、血容量不足和微循环粘滞状态,维持重要脏器的氧供,减少肺水肿等并发症的发生。

Objective To observe the clinical effects of different fluid therapies in treating severe preeclampsia complicated by aseites. Methods Between Jan.2010 and Dec.2012, patients with severe preeclampsia complicated by ascites in Shenzhen Materuity and Child Heahheare Hospital were included in this study. The treatment group （n = 55） were given intravenous drip of 6% hydroxyl starch 130/0.4 plus furosemide, and the control group （n=52） received intravenous drip of 5% human serum albumin plus furosemide.The mean arterial pressure, respiratory rate, heart rate, oxyhemoglobin saturation, colloid osmotic pressure, hematocrit and the incidence of acute pulmonary edema were observed and compared between the two groups. Results Twenty-four hours after cesarean section, the mean arterial pressure of the treatment group was significantly lower than that of the control group, whereas heart rate and oxyhemoglobin saturation were significantly higher （all P〈0.05）.The incidence of acute pubnonary edema of the control group was 17.3%, while no patient in the treatment group developed acute pulmonary edema.On the 5th day after surgery, the hematocrit and 24 h proteinuria were significantly lower in the treatment group, while colloid osmotic pressure was higher （all P〈0.05）.There was no difference in serum albumin level between the two groups （P〉 0.05） .The average duration of edema after treatment was significantly shorter in the treatment group [ （2.43±0.37） d versus （3.74±0.59） d, P〈0. 01 ]. Conclusion 6% hydroxyl starch 130/4.0 plus furosemide can effectively elevate the colloid osmotic pressure, resolve edema, improve hypovolemia, sustain oxygen supply to the organs and decrease the complication of pulmonary edema in patients with severe preeclampsia complicated by ascites.