6％羟乙基淀粉130/0.4用于心脏手术患儿急性血液稀释后血管外渗漏的发生情况

Development of extravascular leakage of 6% hydroxyethyl starch 130/0.4 when used for acute hemodilution in pediatric patients undergoing open heart surgery

目的 评价6％羟乙基淀粉130/0.4用于心脏手术患儿急性血液稀释后血管外渗漏的发生情况.方法 择期行室间隔或房间隔缺损修补术的患儿48例,性别不限,年龄2-12岁,体重12-53 kg,ASA分级Ⅰ或Ⅱ级,按年龄分为2组（n=24）：学龄前组（2岁≤年龄≤6岁）和学龄组（6岁〈年龄≤12岁）.2组患儿气管插管后经中心静脉以0.5 ml·kg^-1·main^-1的速率输注10％血容量的6％羟乙基淀粉130/0.4行急性血液稀释.分别于输注羟乙基淀粉前即刻（T0）和输注结束后15min（T1）、30 min（T2）时,取中心静脉血样,测定血浆胶体渗透压（COP）和血红蛋白（Hb）浓度.同时采用蒽酮比色法测定T1和T2时血浆6％羟乙基淀粉130/0.4浓度,测定T2时尿6％羟乙基淀粉130/0.4浓度.结果 与T0时比较,学龄前组T1和T2时血浆Hb浓度降低,学龄组T1和T2时血浆Hb浓度降低,COP升高（P〈0.05）;2组间各时点血浆Hb浓度及COP比较差异无统计学意义（P〉0.05）.与T1时比较,2组T2时血浆6％羟乙基淀粉130/0.4浓度降低（P〈0.05）.与学龄组比较,学龄前组T1和T2时血浆6％羟乙基淀粉130/0.4浓度降低（P〈0.05）.2组间尿6％羟乙基淀粉130/0.4浓度比较差异无统计学意义（P〉0.05）.结论 6％羟乙基淀粉130/0.4用于心脏手术患儿急性血液稀释后会发生血管外渗漏,学龄前患儿更明显.

Objective To evaluate the development of extravascular leakage of 6% hydroxyethyl starch （HES） 130/0.4 when used for acute hemodilution in the pediatric patients undergoing open heart surgery.Methods Forty-eight American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients,aged 2-12 yr,weighing 12-53 kg,scheduled for elective surgical repair of ventricular or atrial septal defect,were divided into 2 groups （n =24 each） according to age：preschool group （2 yr ≤ age ≤ 6 yr） and school-age group （6 yr〈age ≤ 12yr）.After anesthesia induction and endotracheal intubation,a volume of 6% HES 130/0.4 equivalent to 10% of the blood volume was infused via the central veins at 0.5 ml · kg^-1 · min^-1 in two groups.Immediately before infusion of HES （T0） and at 15 and 30 min after the end of infusion （T1,2）,blood samples were collected fron the central vein for determination of plasma colloid osmotic pressure （COP） and hemnoglobin （Hb） concentrations.The concentrations of 6% HES 130/ 0.4 in plasma at T1 and T2 and in urine at T2 were measured by the anthranone colorimetric method.Results Compared with the baseline value at T0,the concentrations of Hh in plasma were significantly decreased at T1,2 in preschool group,and the concentrations of Hb in plasma were significantly decreased and plasma COP was increased at T1,2 in school-age group （P〈0.05）.There were no significant differences in plasma Hb concentrations or COP at each time point between two groups （P〉0.05）.The plasma 6% HES 130/0.4 concentrations were significantly lower at T2 than at T1 in two groups （P〉0.05）.Compared with school-age group,the plasma 6% HES 130/0.4 concentrations were significantly decreased at T1,2 in preschool group （P〈0.05）.There was no significant difference in 6% HES 130/0.4 concentrations in urine between the two groups （P〉0.05）.Conclusion When 6% HES 130/0.4 is used for acute hemodilution,extravascular leakage happens after acute hemodilution and is more obvious in the preschool pediatric patients undergoing open heart surgery.