6%羟乙基淀粉130/0.4电解质注射液用于脑膜瘤切除术患者液体治疗的效果

Efficacy of 6% hydroxyethyl starch 130/0.4 electrolyte solution for fluid therapy in patients undergoing meningioma resection

目的评价6%羟乙基淀粉130/0.4电解质注射液用于脑膜瘤切除术患者液体治疗的效果。方法择期行脑膜瘤切除术患者92例,年龄18~64岁,ASA分级Ⅰ级或Ⅱ级,BMI 18~30 kg/m2,性别不限,预计手术时长>3 h。采用随机数字表法将患者分为2组(n=46):乳酸钠林格液组(LR组)和羟乙基淀粉组(HES组)。LR组全程静脉输注乳酸钠林格液,HES组静脉输注6%羟乙基淀粉130/0.4电解质注射液,最大剂量不超过50 ml/kg,超出部分以乳酸钠林格液补充。采用目标导向液体治疗,维持SVV<13%,MAP 70~90 mmHg。分别于麻醉诱导前即刻(T0)、液体输注1000和2000 ml(T1,2)时、术毕即刻(T3)行动脉血气分析,同时监测血栓弹力图。记录术中电解质紊乱、酸碱平衡失调、凝血功能异常的发生情况和去甲肾上腺素用量。术后3和7 d时随访,记录QoR-15评分。记录术后住院时间、脑水肿、肺水肿和恶心呕吐的发生情况。结果LR组和HES组分别有4例和6例因手术时间过长被排除,最终2组分别纳入42例和40例。与LR组比较,HES组T3时血浆Na+浓度升高,T1-3时血浆Cl-浓度和pH值升高,T2,3时血浆Ca2+浓度降低,T3时反应时间升高,T2,3时凝血时间升高,最大振幅降低,T1-3时凝固角降低(P<0.05)。2组均未发生电解质紊乱及凝血功能异常。2组术中去甲肾上腺素用量和碱中毒发生率、术后Qor-15评分、住院时间、肺水肿、脑水肿及恶心呕吐发生率比较差异无统计学意义(P>0.05)。结论相对于乳酸钠林格液而言,6%羟乙基淀粉130/0.4电解质注射液用于脑膜瘤切除术患者液体治疗的效果无差异。

Objective To evaluate the efficacy of 6%hydroxyethyl starch(HES)130/0.4 electrolyte solution for fluid therapy in the patients undergoing meningioma resection.Methods Ninety-two American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients of either sex,aged 18-64 yr,with body mass index of 18-30 kg/m2,with expected operation duration>3 h,undergoing elective meningioma resection,were divided into 2 groups(n=46 each)using a random number table method:lactated Ringer′s solution(LR)group and HES group.LR was infused throughout operation in group LR,and 6%HES was intravenously infused in group HES,with the maximum dose not exceeding 50 ml/kg,and the excess part was supplemented with LR.Goal-directed fluid therapy was used to maintain stroke volume variation<13%and mean arterial pressure 70-90 mmHg.Arterial blood gas analysis was performed immediately before anesthesia induction(T0),when 1000 and 2000 ml of fluid were infused(T1,2),and at the end of surgery(T3)to record electrolyte and acid-base balance indexes.Thromboelastogram was simultaneously monitored.The occurrence of electrolyte disorder,acid-base imbalance and abnormal coagulation function and consumption of norepinephrine were recorded.Patients were followed up at 3 and 7 days after surgery,and the Chinese quality of recovery-15 scores were recorded.The hospitalization time and occurrence of brain edema,pulmonary edema,nausea and vomiting were recorded.Results In group L and group H,4 cases and 6 cases were excluded due to prolonged operation time,and 42 cases and 40 cases were finally included,respectively.Compared with LR group,the plasma Na+concentration was significantly increased at T3,the plasma Cl-concentration and pH value were increased at T1-3,the plasma Ca2+concentration was decreased at T2,3,reaction time was increased at T3,coagulation time was increased and maximum amplitude was decreasedat T2,3,and coagulation Angle was decreased at T1-3(P<0.05).No electrolyte disorder and abnormal coagulation function was found in the two groups.There was no statistically significant difference in the consumption of norepinephrine,postoperative Chinese quality of recovery-15 score,length of hospital stay and incidence of alkalosis,pulmonary edema,brain edema,and nausea and vomiting between the two groups(P>0.05).Conclusions The efficacy of liquid therapy is comparable between HES and LR in the patients undergoing meningioma resection.