羟乙基淀粉对消化道肿瘤根治术后早期血浆白蛋白及炎性介质变化的影响

Effects of hydroxyethyl starch on the change of plasma albumin and inflammatory mediators in patients with gastrointestinal neoplasms after radical resection

目的探讨羟乙基淀粉对消化道肿瘤根治术后早期血浆白蛋白及炎性介质变化的影响。方法选择45例消化道肿瘤根治术后即刻静脉滴注羟乙基淀粉溶液治疗的患者(观察组)和45例术后即刻静脉滴注同等量0.9%Na Cl溶液治疗的患者(对照组),均连续静脉滴注7 d,采用免疫比浊法检测两组患者术后早期血浆白蛋白水平;采用酶联免疫吸附试验检测两组患者治疗前后C-反应蛋白、白细胞介素-6和肿瘤坏死因子-α水平,比较两组患者临床疗效和术后早期血浆白蛋白、炎性介质水平的变化。结果术前,两组患者C-反应蛋白、白细胞介素-6和肿瘤坏死因子-α水平比较,差异均无统计学意义(P﹥0.05)。术后第1、3、5、7天,观察组患者血浆白蛋白水平均高于对照组(P﹤0.05)。术后第7天,观察组患者C-反应蛋白和白细胞介素-6水平均低于对照组(P﹤0.05);观察组患者治疗后肿瘤坏死因子-α水平高于对照组(P﹤0.05)。观察组患者术后并发症的发生率为6.67%,与对照组的8.89%比较,差异无统计学意义(P﹥0.05)。结论对于消化道肿瘤根治术患者,术后早期静脉滴注羟乙基淀粉溶液治疗,效果理想,可以调节血浆白蛋白和炎性介质水平,改善手术预后,值得临床推广应用。

Objective To investigate the effect of hydroxyethyl starch on the early change of plasma albumin and inflammatory mediators in patients with gastrointestinal cancer after radical resection. Method 90 patients with gastrointestinal tumor were randomized to be administered with intravenous infusion of hydroxyethyl starch（n=45, study group）or equivalent 0.9%Na Cl（n=45, control group） immediately following radical resection（n=45） for 7 consecutive days, immunoturbidimetry was utilized to detect the postoperative serum albumin level in early stage; enzyme-linked immunosorbent assay was used to detect the C-reactive protein（CRP）, interleukin（IL）-6 and tumor necrosis factor（TNF）-α levels before and after treatment, the clinical curative effect, the change of postoperative plasma albumin and inflammatory mediators were compared between the two groups. Result Before surgery, the level of plasma albumin, IL-6 and TNF-αwere similar between the two groups（P〈0.05）. In 1, 3, 5 and 7 d after surgery, the plasma albumin level was significantly higher in study group than control group（P〈0.05）. In 7 d after surgery, the CRP and IL-6 level were lower（P〈0.05）,while TNF-α was higher in study group than in control group（P〈0.05）. The incidence of complications was 6.67% in study group, which was comparable with that in control group at 8.89%（P〈0.05）. Conclusion For patients who underwent radical resection for gastrointestinal tumor, early intravenous infusion of hydroxyethyl starch is effective to improve the postoperative prognosis, which may regulate the level of plasma albumin and inflammatory mediators.