羟乙基淀粉急性等容血液稀释对剖腹产患者血流动力学及异体输血的影响

Effects of of acute normovolaemic haemodilution of hydroxyethyl starch on hemodynamic and allogeneic blood transfusion in cesarean section patients

目的:羟乙基淀粉急性等容血液稀释(ANH)对剖腹产患者血流动力学及异体输血的影响。方法:将69例剖腹产手术患者随机分为对照组、乳酸钠组和羟乙基淀粉组,每组23例。乳酸钠组和羟乙基淀粉组麻醉后行ANH,对照组不进行ANH。乳酸钠组扩容液为乳酸钠林格氏液,羟乙基淀粉组扩容液为6%羟乙基淀粉130/0.4。记录血液稀释前5min(对照组为俯卧位前5 min,T_0)、血液稀释后10 min(对照组为切皮前5 min,T_1)、输血前5min(T_2)和输血后10min(T_3)时的平均动脉压(MAP)、心率(HR)、心脏指数(CI)、每搏量变异率(SVV)及血红蛋白(Hb)、血细胞压积(Hct)、血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)。观察3组手术时间、术中失血量、异体血输注例数、尿量等指标。结果:(1)乳酸钠组T_2和T_3时MAP明显低于T_0时、羟乙基淀粉组和对照组,SVV明显高于T_0时、羟乙基淀粉组和对照组,差异有统计学意义(P<0.05);乳酸钠组和羟乙基淀粉组T_1时CI明显高于T_0时和对照组,羟乙基淀粉组和对照组T_2和T_3时CI明显高于T_0时和乳酸钠组,差异有统计学意义(P<0.05)。(2)与T_0时比较,乳酸钠组和羟乙基淀粉组T_1、T_2、T_3时Hb、Hct及PLT明显降低,T_1、T_2时Hb、Hct及PLT明显低于对照组,T_3时明显高于对照组,差异有统计学意义(P<0.05)。与T_0时比较,3组T_2、T_3时PT、APTT明显延长,乳酸钠组和羟乙基淀粉组T_3时PT、APTT明显短于对照组,差异有统计学意义(P<0.05)。(3)乳酸钠组和羟乙基淀粉组异体血输注例数明显少于对照组,乳酸钠组尿量明显多于羟乙基淀粉组和对照组,差异有统计学意义(P<0.05)。结论:ANH可有效减少剖腹产患者术中异体输血。羟乙基淀粉行ANH更有利于患者血流动力学的稳定。

Objective：To explore the effects of of acute normovolaemic haemodilution（ANH）of hydroxyethyl starch on the hemodynamic and allogeneic blood transfusion in cesarean section patients.Method：A total of 69 cases of cesarean section patients were divided randomly into control group,sodium lactate group and hydroxyethyl starch group,23 cases in each group.The patients in sodium lactate group and hydroxyethyl starch group were given ANH after anesthesia,the patients in control group were not given ANH.The expansion fluid was sodium lactate ringer＇s solution in sodium lactate group,and 6%hydroxyethyl starch 130/0.4 in hydroxyethyl starch group.Mean arterial pressure（MAP）,heart rate（HR）,cardiac index（CI）,stroke volume variation rate（SVV）and hemoglobin（Hb）,hematocrit（Hct）,platelet（Plt）,prothrombin time（PT）,activated partial thromboplastin time（APTT）at 5 min before hemodilution（control group for 5 min before prone position,T0）,10 min after hemodilution（control group for 5 min before cutting leather,T1）,5 min before blood transfusion（T2）and 10 min after blood transfusion（T3）were recorded.Operation time,intraoperative blood loss,allogeneic blood transfusion cases,urine volume were observed in three groups.Result：（1）MAP at T2,T3 were lower significantly in sodium lactate group than T0 and those in hydroxyethyl starch group and control group,SVV at T2,T3 were higher significantly in sodium lactate group than T0 and those in hydroxyethyl starch group and control group,and the difference were statistically significant（P〈0.05）.CI at T1 was higher significantly in sodium lactate group and hydroxyethyl starch group than T0 and that in control group,CI at T2,T3 were higher significantly in hydroxyethyl starch group and control group than T0 and those in sodium lactate group,and the difference were statistically significant（P〈0.05）.（2）Compared with T0,Hb,Hct and PLT at T1,T2,T3 in sodium lactate group andhydroxyethyl starch group decreased significantly,Hb,Hct and Plt at T1,T2 in sodium lactate group and hydroxyethyl starch group were lower significantly than those in control group,Hb,Hct and Plt at T3 in sodium lactate group and hydroxyethyl starch group were higher significantly than those in control group,and the difference were statistically significant（P〈0.05）.Compared with T0,PT and APTT at T2,T3 in three groups extended obviously,PT and APTT at T3 in sodium lactate group and hydroxyethyl starch group were shorter significantly than those in control group,and the difference were statistically significant（P〈0.05）.（3）Allogeneic blood transfusion cases in sodium lactate group and hydroxyethyl starch group was less significantly than that in control group,urine output in sodium lactate group was obviously more than that in hydroxyethyl starch group and the control group,and the difference were statistically significant（P〈0.05）.Conclusion：ANH could reduce effectively allogeneic blood transfusion in cesarean section patients.Hydroxyethyl starch may be more superior to the stability of hemodynamics.