术前羟乙基淀粉胶体液治疗对麻醉诱导期间血流动力学的影响

Effect of preoperative hydroxyethyl starch colloidal solution therapy on hemodynamics during anesthesia induction

目的探讨术前羟乙基淀粉胶体液治疗对麻醉诱导期间血流动力学的影响。方法选择2018年1月至2020年12月北京市第六医院收治的年龄33~71岁行腹部和盆腔大手术的患者60例。按照随机数字表法分为观察组和对照组,各30例。对照组患者除麻醉诱导时控制相同胶体液输注100 ml以外,不再进行任何液体输注;观察组患者入手术室后以6 ml/kg瘦体重静脉输注羟乙基淀粉胶体液。比较2组患者入室后(基础值)、气管插管即刻、气管插管即刻至气管插管后21 min内(麻醉诱导后)平均动脉压(MAP)、心率以及MAP低于65 mmHg(1 mmHg=0.133 kPa)及55 mmHg的比例,比较2组患者术后7 d心血管事件发生率、肾功能不全发生率、伤口感染发生率、30 d病死率以及术后住院时间。结果麻醉诱导后,观察组MAP明显高于对照组,MAP<65 mmHg及MAP<55 mmHg比例明显低于对照组[(71±18)mmHg比(58±14)mmHg、13.3%(4/30)比56.7%(17/30)、6.7%(2/30)比36.7%(11/30)],差异均有统计学意义(均P<0.05)。所有患者均未因试验干预发生严重相关并发症、未出现肾功能不全,30 d内无死亡。2组患者术后心血管事件发生率、伤口感染发生率及术后住院时间差异均无统计学意义(均P>0.05)。结论术前羟乙基淀粉胶体液治疗可降低麻醉诱导期间低血压的发生率。

Objective To analyze the effect of preoperative hydroxyethyl starch colloidal solution therapy on hemodynamics during anesthesia induction.Methods Totally 60 patients aged 33-71 years who underwent major abdominal and pelvic surgery in Beijing NO.6 Hospital from January 2018 to December 2020 were selected.They were divided into observation group and control group according to the random number table method,with 30 cases in each group.Patients in the control group did not receive any liquid infusion except 100 ml of the same colloidal liquid during anesthesia induction;after entering the operating room,patients in the observation group were infused with hydroxyethyl starch colloid solution with 6 ml/kg lean body weight formula.The mean arterial pressure(MAP),heart rate and the proportions of MAP lower than 65 mmHg and 55 mmHg were compared between the two groups after entering operating room(baseline),immediate endotracheal intubation and within 21 min after immediate endotracheal intubation(after anesthesia induction).The incidences of cardiovascular events 7 d after operation,renal insufficiency,wound infection,fatality rate after 30 d and postoperative length of stay were compared between the two groups.Results After anesthesia induction,MAP in the observation group was significantly higher than that in the control group,and the proportions of MAP<65 mmHg and MAP<55 mmHg in the observation group were significantly lower than those in the control group[(71±18)mmHg vs(58±14)mmHg,13.3%(4/30)vs 56.7%(17/30),6.7%(2/30)vs 36.7%(11/30)](all P<0.05).All patients had no serious related complications and renal insufficiency due to experimental intervention,and there was no death within 30 d.There were no significant differences in the postoperative cardiovascular events rate,wound infection rate and postoperative length of stay between the two groups(all P>0.05).Conclusion Preoperative hydroxyethyl starch colloidal solution therapy can decrease the incidence of hypotension after anesthesia induction.