Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache:Twenty case reports and a review of the literature

BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARY We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch(HES)to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures.ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section(CS)and in eleven parturients receiving labor analgesia.An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients.After CS,the epidural catheter was used for postoperative pain relief over a 48-h period.After delivery in eleven cases,epidural infusion was maintained for 24 h.Thereafter,15 mL of 6%HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal.None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSION An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.

Positional and Quantitative Characterization of the Hydroxyethyl Groups in Hydroxyethyl Starch by GC/MS or NMR

The position and quantity of the hydroxyethyl groups in hydroxyethyl starch (HES) were studied by GC/MS and NMR. Quantitative characterization was carried out based on the results of both methods.

The Volume Effect and Safety of 6% Hydroxyethyl Starch 130/0.4 in Patients Undergoing Major Elective Surgery: An Uncontrolled, Open-Labeled, Multi-Center Study

Purpose: The primary aim of this study was to investigate volume effect and safety of up to 50 mL/kg BW 6% hydroxyethyl starch (HES) 130/0.4 in adult and pediatric patients undergoing major elective surgery. The need to infuse human albumin may be reduced or avoided in Japan if these large doses 6% HES 130/0.4 can be infused. Methods: The study was an uncontrolled, open-labeled, multi-center trial. Fifteen adult and 5 pediatric patients undergoing major elective surgery received 6% HES 130/0.4 (Voluven&#174) with a maximum dose of 50 mL/kg from the start of surgery until 2 hours after the end of surgery according to a treatment algorithm. The primary efficacy endpoint was the volume effect of 6% HES 130/0.4 determined by the volume of saved albumin during the investigational period and the time course of hemodynamic stability in adult and pediatric patients. Safety parameters were fluid balance, hemodynamic and laboratory parameters ECG, local and systemic tolerance and adverse events. Results: Adult patients received a mean of 32.0 mL/kg of 6% HES 130/0.4. For 12 out of 15 adult patients an average amount of 1033.8 mL (18.6 mL/kg) albumin could be saved. The other 3 adult patients did not receive more than 1000 mL of HES 130/0.4. All pediatric patients received approximately 50 mL/kg of HES 130/0.4;for these patients an average amount of 39.9 mL/kg body weight albumin could be saved. The majority of adult patients, and all pediatric patients were hemodynamically stable at all 3 time points. The observed changes of the assessed laboratory parameters including hematological and coagulation parameters or in any other safety parameter determined did not reveal any safety concern related to the administration of 6% HES 130/0.4 up to doses of 50 mL/kg body weight. Conclusion: The study results indicate that 6% HES 130/0.4 has a reliable volume effect, could contribute to significant human albumin savings and was safe and well tolerated up to a maximum dose of 50 mL/kg body weight in adult and pediatric patients undergoing major elective surgery.

A Comparative Retrospective Analysis of Mortality, Renal Dysfunction, and Incidence of Bleeding in Patients Receiving Hydroxyethyl Starch 130/0.4 (HES 130/0.4) or Albumin

Background: In June 2013, the FDA issued a Black Box Warning on synthetic colloids resulting from data indicating an increased risk of mortality, renal injury, and excess bleeding incidence in septic patients admitted to the Intensive Care Unit (ICU), and patients undergoing coronary artery bypass graft (CABG) surgery. The purpose of this study was to compare the incidence of mortality, incidence/severity of renal injury and bleeding in septic ICU patients, and patients undergoing CABG surgery who have received hydroxyethyl starch 130/0.4 or albumin. Methods: This was a retrospective, single center, cohort study conducted at a 433 bed tertiary care hospital in Lexington, Kentucky. Computer generated lists provided patients who received hydroxyethyl starch 130/0.4 or albumin during inpatient stay as either a sepsis patient in the ICU or post coronary artery bypass graft patient. All cause mortality was the primary endpoint and secondary endpoints included overall renal dysfunction, incidence of bleeding, and overall length of stay. Results: A total of 89 patients were evaluated that received albumin or hydroxyethyl starch 130/0.4 alone with either septic ICU or CABG diagnosis codes. There was no significant difference in all cause mortality (p = 0.64). Overall renal dysfunction showed no statistically significance between the two groups (p = 0.66). There was no statistically significant difference between the albumin or HES 130/0.4 arms with respect to bleeding (TIMI Minimal p = 0.57, TIMI Minor p = 0.69, TIMI Major p = 0.35). Patient who received albumin had a statistically significant longer hospital overall length of stay (p = 0.003). Conclusion: There was no difference between HES 130/0.4 and albumin in mortality, renal dysfunction, and bleeding in septic ICU and CABG patients. Patients receiving albumin had an increased overall length of stay. These findings suggest that hydroxyethyl starch 130/0.4 may be safe in the studied patient populations;however, further investigation into specific HES agents should be conducted.

Targeting cancer-associated fibroblasts with hydroxyethyl starch nanomedicine boosts cancer therapy

Cancer-associated fibroblasts(CAFs)play an important role in facilitating the progression of triple-negative breast cancer(TNBC)by deteriorating the tumor mechanical microenvironment(TMME).Herein,we designed a CAFs-targeting nanomedicine by conjugating doxorubicin(DOX)-loaded hydroxyethyl starch-IR780 nanoparticles(NPs)with Cys-Arg-Glu-Lys-Ala(CREKA)peptide,which had a special affinity for fibronectin overexpressed on CAFs.After systemic administration,the NPs efficiently targeted CAFs and generated hyperthermia upon light irradiation,decreasing CAFs through the combination of chemo-and photothermal-therapies.Thus,a series of changes in TMME were achieved by reducing CAFs,which further disrupted the niche of cancer stem cells(CSCs)to affect their survival.As a result,the tumor growth was significantly inhibited in 4T1 tumors.The strategy of TMME modulation and CSCs elimination through targeting and depleting CAFs provides a novel therapeutic treatment for desmoplastic solid tumors.

Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture

Background:No convincing modalities have been shown to completely prevent postdural puncture headache(PDPH)after accidental dural puncture(ADP)during obstetric epidural procedures.We aimed to evaluate the role of epidural administration of hydroxyethyl starch(HES)in preventing PDPH following ADP,regarding the prophylactic efficacy and side effects.Methods:Between January 2019 and February 2021,patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital.The development of PDPH,severity and duration of headache,adverse events associated with prophylactic strategies,and hospital length of stay postpartum were reported.Results:A total of 105 patients experiencing ADP received a re-sited epidural catheter.For PDPH prophylaxis,46 patients solely received epidural analgesia,25 patients were administered epidural HES on epidural analgesia,and 34 patients received two doses of epidural HES on and after epidural analgesia,respectively.A significant difference was observed in the incidence of PDPH across the groups(epidural analgesia alone,31[67.4%];HES-Epidural analgesia,ten[40.0%];HES-Epidural analgesia-HES,five[14.7%];P<0.001).No neurologic deficits,including paresthesias and motor deficits related to prophylactic strategies,were reported from at least 2 months to up to more than 2 years after delivery.An overall backache rate related to HES administration was 10%.The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP(OR=0.030,95%confidence interval:0.006-0.143;P<0.001).Conclusions:The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP.This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES,respectively,on and after epidural analgesia.The efficacy and safety profiles of this strategy have to be investigated further.

Effects of the novel 6 % hydroxyethyl starch 130/0.4 on renal function of recipients in living-related kidney transplantation

Background The optimal colloid for use during kidney transplantation is not clear. Patients undergoing living-related kidney transplantation （LRKT） were used to compare the protective effects of 6% hydroxyethyl starch 130/0.4 （HES 130/0.4） and 4% succinylated gelatine, as donor kidney procurement, ischemia time and surgical conditions are comparable. Stroke volume variation （SVV） was used to monitor intravascular volume to avoid renal allograft hypoperfusion.Methods Eighty patients undergoing LRKT were divided into two groups： group H received 6% HES 130/0.4 and group G received 4% succinylated gelatine. All donors and recipients received 15-25 ml/kg of the relevant colloid during surgery. Arterial blood pressure （ABP）, heart rate （HR）, central venous pressure （CVP）, SVV and cardiac index （CI）,electrocardiography （ECG） and SpO2 were monitored continuously. SVV was kept between 6%-13% and mean arterial pressure at 100-130 mmHg. Samples of venous blood and urine were obtained 30 minutes after unclamping and on the mornings of post-operative days （POD） 1-4 to measure serum and urine β2-microglobulin, urine α1-microglobulin,microalbumin and N-acetyl-β-D-glucosaminidase. Blood urea nitrogen （BUN） and creatine were determined pre-operation （to）, 3 hours after surgery （t1） and on PODs 1 （t2）, 2 （t3）, 4 （t4）, 7 （t5） and 10 （t6）. Urine output was recorded at t1, t2, t5, t6.Results Age, body weight, body surface area （BSA）, operation time, urine output and the colloid volume infused were comparable between the groups and hemodynamics were stable during surgery. BUN, serum creatine, serum β2-microglobulin and urine β2-microglobulin decreased significantly after surgery in both groups relative to the baseline.BUN decreased significantly in group H compared with group G at t1, t2 and t4. Urine microalbumin decreased significantly in group H on POD 4 compared with group G. Urine α1-microglobulin was not significantly different between the two groups.Conclusion Both colloids can be safely used for LRKT, but HES130/0.4 was associated with a more rapid recovery of renal function.

Protective effects of hydroxyethyl starch 130/0.4 against myocardial ischemia/reperfusion injury in rats

Background The effects of hydroxyethyl starch 130/0.4 （HES130/0.4） on myocardial ischemia/reperfusion （I/R） injury and its mechanism are uncertain.The aim of this study was to investigate the protective effects of HES 130/0.4 on myocardial I/R injury.Methods Forty-eight Sprague-Dawley rats were assigned to sham-operation group （S group）,ischemia-reperfusion group （I/R group）,albumin-I/R group （A-I/R group） and HES130/0.4-I/R group （H-I/R group）.The fluids were administered at 25 minutes after ischemia.H-I/R group was given 7.5 ml/kg of HES 130/0.4;I/R group and A-I/R group received the same volume of normal saline and 5% albumin,respectively.The rats in S group were sham operated and received the same fluid as I/R group.After 30 minutes of ischemia and 3 hours of reperfusion,blood samples were taken for cytokines assay,myocardium was excised for detection of NF-κB activity and myocardial infarction areas were taken for immunohistochemical analysis.Results Hemodynamic parameters of H-I/R group were better than I/R and A-I/R groups at all designated time points.The results of 2,3,5-triphenyl-tetrazolium（TTC） and HE staining were better in the H-I/R group.Myeloperoxidase （MPO）,NF-κB activity and concentrations of TNF-α,IL-1β were elevated markedly in I/R groups.HES130/0.4 lessened the release of TNF-α and IL-1β consistent with the reduction of MPO activity,and HES 130/0.4 inhibited the activity of NF-κB in H-I/R group.The number of apoptotic cells in the H-I/R group was also significantly reduced compared with I/R and A-I/R group Conclusion HES130/0.4 has a protective effect on I/R injured myocardium,probably by inhibiting NF-κB activity,reducing the release of pro-inflammatory cytokines and interfering with the apoptosis of cardiomyocytes.

Sources of Heterogeneity in Trials Reporting Hydroxyethyl Starch 130/0.4 or 0.42 Associated Excess Mortality in Septic Patients： A Systematic Review and Meta-regression

Background： This meta-analysis was to determine the association of the cumulative dose of 130/0.4 or 0.42 （hydroxyethyl starch [HES] 130/0.4＊） or delta daily fluid balance （i.e., daily fluid balance in HES group over or below control group） with the heterogeneity of risk ratio （RR） for mortality in randomized control trials （RCTs）. Methods： Three databases （PubMed, EMBASE, Cochrane） were searched to identify prospective RCTs reporting mortality in adult patients with sepsis to compare HES 130/0.4＊ with crystalloids or albumin. Meta-analysis was performed using random effects. Sensitivity and meta-regression analyses were used to examine the heterogeneity sources of RR for mortality, Results： A total number of 4408 patients from 11 RCTs were included. The pooled RR showed no significant difference for overall mortality in patients with administration of liES130/0.4＂ compared with treatment of control fluids （RR： 1.02, 95% confidence interval： 0.9-1.17; P = 0.73）. Heterogeneity was moderate across recruited trials （l^2 = 34%, P = 0.13）. But, a significant variation was demonstrated in subgroup with crystalloids as control fluids （l^2 = 42%, P 〈 0.1）. Sensitivity analysis revealed that trials with high risk of bias did not significantly impact the pooled estimates for mortality. Meta-regression analysis also did not determine a dose-effect relationship of HES 130/0.4＊ with mortality （P - 0.298）, but suggested daily delta fluid balance being likely associated with mortality in septic patients receiving HES130/130/0.4＊ （P = 0.079）.Conclusions： Inappropriate daily positive fluid balance was likely an important source of heterogeneity in these trials reporting HES 130/0.4＊ associated with excess mortality in septic patients.

Effect of volume replacement with hydroxyethyl starch solution on splanchnic oxygenation in patients undergoing cytoreductive surgery for ovarian cancer

Objective To investigate the effectiveness of using a medium molecular weight hydroxyethyl starch solution (HES) administered as a replacement for estimated blood loss (EBL) during cytoreductive surgery for ovarian cancer on splanchnic oxygenation Methods Forty two patients undergoing cytoreductive surgery for ovarian cancer were enrolled in this prospective randomized study As soon as the EBL exceeded 10% but was less than 20% of the estimated blood volume, the patients were randomly assigned to receive either a volume of lactated Ringer's solution (LRS) equal to three times the EBL (LRS group, n=22) or a volume of 6% HES equal to the EBL (HES group, n=20) Tissue oxygenation was assessed indirectly by measuring tonometric parameters, including the difference between gastric intramucosal PsCO 2 and arterial PaCO 2 (Ps a CO 2 gap), gastric intramucosal pH (pHi) and arterial lactate acid concentration at 30 min after induction of anesthesia (baseline value), 1 hour and 2 hours after skin incision, and at the end of surgery Results At the end of surgery,the Ps a CO 2 gap in the HES group (8 7±1 6 mmHg) was significantly lower than that of the LRS group (18 74±4 4 mmHg, P <0 01), while the pHi (7 30±0 05 mmHg) in the HES group was significantly higher than that of the LRS group (7 21±0 07 mmHg, P <0 01) There was no significant difference between the two groups in terms of arterial lactate acid concentration Conclusion In patients undergoing major surgery with relatively large blood losses, volume resuscitation with medium molecular weight hydroxyethyl starch solution may improve splanchnic blood flow and tissue oxygenation

Hydroxyethyl starch and its derivatives as nanocarriers for delivery of diagnostic and therapeutic agents towards cancers

Many types of drugs and agents used for cancer diagnosis and therapy often have low bioavailability and insufficient efficacy,as well as causing various side effects due to their nonspecific delivery.Nanocarriers with purposely-designed compositions and structures have shown varying degrees of abilities to deliver these compounds towards cancers in passive or active manners.Despite the availability of a variety of materials for the construction of nanocarriers,natural polymers with good biocompatibility and biodegradability are preferable for such usage because of their high in vivo safety as well as easy removal of degradation products.Among the natural polymers intended for building nanocarriers,hydroxyethyl starch and its derivatives have gained tremendous attention in the field of drug delivery in the form of nanomedicines over the last decade.There is growing optimism that ever more hydroxyethyl starch-based nanomedicines will be a significant addition to the armoury currently used for cancer diagnosis and therapy.

不同晶体液早期复苏在老年感染性休克患者中的应用效果及对血流动力学参数、呼吸指标的影响

目的探究不同晶体液早期复苏在老年感染性休克患者中的应用效果及对血流动力学参数、呼吸指标的影响。方法选择2019年2月至2022年3月我院收治的80例老年感染性休克患者作为研究对象,以随机数字表法将其分为对照组和观察组,每组40例。在常规治疗基础上,对照组给予乳酸林格液,观察组给予羟乙基淀粉溶液。比较两组的复苏效果。结果复苏后,观察组的急性生理学及慢性健康状况评分系统(APACHEⅡ)评分低于对照组(P<0.05);观察组的机械通气时间、ICU入住时间、复苏时间均短于对照组(P<0.05)。复苏后,观察组的平均动脉血压(MAP)、心输出量(CO)、心脏指数(CI)高于对照组,每搏量变异度(SVV)低于对照组(P<0.05)。复苏后,观察组的动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))高于对照组,氧减指数(ODI)、呼吸频率(RR)低于对照组(P<0.05)。观察组休克0~6 h、休克>6~12 h晶体液用量以及总用量显著少于对照组(P<0.05)。结论羟乙基淀粉溶液在老年感染性休克患者早期液体复苏治疗中的效果显著,不仅能降低晶体液用量,还能改善患者血流动力学参数及呼吸指标,缩短ICU入住时间,值得推广。

高渗羟乙基淀粉行急性等容血液稀释对患者血流动力学、动脉血气及凝血功能的影响

目的:探讨高渗氯化钠羟乙基淀粉40和羟乙基淀粉130/0.4行急性等容血液稀释(Acute normovolaemic hemodilution,ANH)对腰椎融合术患者血流动力学、动脉血气及凝血功能的影响。方法:选择行腰椎融合术的患者50例,随机分为高渗氯化钠羟乙基淀粉组(高渗组)和羟乙基淀粉130/0.4组(对照组),每组25例,行自体血收集的同时回输液体。高渗组:回输0.5倍自体血采集量的高渗氯化钠羟乙基淀粉40注射液;对照组:回输与自体血相等体积的羟乙基淀粉130/0.4氯化钠注射液,采血量根据Gross公式将2组患者经血液稀释后的红细胞压积控制在30%。在ANH前5 min(T_1)、ANH结束后10 min(T_2)、自体血输血前5 min(T_3)、自体血输血结束后10 min(T_4)4个时间点记录患者的心率、平均动脉压,在T_1、T_2、T_4时行动脉血气分析,在T_1、T_4时行血栓弹力图检测。监测2组患者手术时间、术中失血量、术中异体血输注量、术中输液量、术中尿量、术中血管活性药使用情况及并发症发生情况等。结果:在T_3时点,高渗组患者平均动脉压明显低于对照组,差异有统计学意义(P<0.05),其他各时点2组平均动脉压比较差异无统计学意义(P>0.05)。高渗组9例(36.0%)术中使用了血管活性药,对照组2例(8.0%)术中使用了血管活性药,差异有统计学意义(P<0.05)。高渗组患者术中尿量明显多于对照组,差异有统计学意义(P<0.05)。2组患者动脉血气分析和血栓弹力图相关参数比较,差异均无统计学意义(P>0.05)。结论:对腰椎融合术患者使用高渗氯化钠羟乙基淀粉40和羟乙基淀粉130/0.4行急性等容血液稀释均安全可行,具有一定的血液保护效应。术中行ANH应根据不同液体的理化性质加强对容量的监测和管理。

内镜下黏膜剥离术联合术后羟乙基淀粉治疗对上消化道早癌疗效及血清指标水平的影响

目的分析内镜下黏膜剥离(endoscopic submucosal dissection,ESD)术联合术后羟乙基淀粉治疗对上消化道早癌疗效及血清白蛋白(albumin,ALB)、二胺氧化酶(diamine oxidase,DAO)水平的影响。方法将四川大学华西医院2018年1月至2021年8月间收治的106例上消化道早癌患者随机分为观察组及对照组,每组各53例;对照组采用ESD术治疗,观察组采用ESD术联合术后羟乙基淀粉治疗;记录2组患者出血率、穿孔率、局部复发率;术前及术后4周时检测患者血清中ALB、DAO、C反应蛋白(C⁃reactive protein,CRP)、白细胞介素⁃6(interleukin⁃6,IL⁃6)及肿瘤坏死因子⁃α(tumor necrosis factor⁃α,TNF⁃α)水平。结果术后4周观察组患者的ALB水平明显高于对照组,DAO水平明显低于对照组,差异有统计学意义(P<0.05);术后4周观察组患者血清中CRP、IL⁃6及TNF⁃α水平明显低于对照组,差异有统计学意义(P<0.05);术后4周观察组患者出血率、穿孔率及局部复发率均低于对照组,差异有统计学意义(P<0.05)。结论ESD术联合术后羟乙基淀粉治疗上消化道早癌患者可显著改善其临床疗效及血清ALB、DAO水平。

6%羟乙基淀粉130/0.4对创伤性家兔炎症介质及其信号通路的影响

目的 探讨6%羟乙基淀粉(HES)130/0.4对创伤性家兔炎症介质及其信号通路——微小RNA(miR)-146a/Toll样受体-4(TLR4)/核因子-κB(NF-κB)的影响。方法 2022年4月选取新西兰雄性家兔16只,麻醉后用钝器敲打家兔的后肢造成后肢骨折,然后行骨折切开内固定术。常规备皮、消毒,骨折部位外侧切口,显露股骨骨折部位,胯骨折线置入合适的国产四孔钢板,在骨折对应的肌肉组织2 cm×2 cm制作软组织缺损模型,同时,取血液和骨折部分肌肉组织备检(T_(0))。将家兔采用随机数字表法分为乳酸钠林格(LR)组和HES组,每组8只。LR组注射10 mL/kg LR,HES组注射10 mL/kg HES,每天1次,输注5 d,结束后将家兔麻醉取损伤部位肌肉组织备检(T_(1))。采用酶联免疫吸附试验法测定T_(0)、T_(1)时家兔血液肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、IL-6等,蛋白质印迹法测定T_(0)、T_(1)时家兔肌肉组织NF-κB P65、TLR4、IL-1受体相关激酶1(IRAK1)和TNF受体相关因子6(TRAF6)蛋白,逆转录-聚合酶链反应法检测T_(0)、T_(1)时家兔肌肉组织miR-146a。结果 与T_(0)时比较,2组家兔T_(1)时血液TNF-α、IL-1、IL-6水平,以及肌肉miR-146a、NF-κB P65、TLR4、IRAK1、TRAF6蛋白水平均明显升高,差异均有统计学意义(P<0.05)。与LR组比较,HES组家兔T_(1)时血液TNF-α、IL-1、IL-6水平,以及肌肉组织NF-κB P65、TLR4、IRAK1、TRAF6蛋白水平均明显降低,肌肉组织miR-146a表达水平明显升高,差异均有统计学意义(P<0.05)。结论 HES可能通过上调miR-146a表达水平,负反馈调节TLR4信号通路上的IRAK1、TRAF6,抑制炎症介质的产生而减轻创伤家兔的炎性反应。

羟乙基淀粉联合乳酸钠林格注射液在重症急性胰腺炎患者早期液体复苏治疗中的应用效果

目的 观察羟乙基淀粉联合乳酸钠林格注射液在重症急性胰腺炎(SAP)患者早期液体复苏治疗中的应用效果。方法 按照计算机分组法将2020年7月—2022年4月福建医科大学附属三明第一医院收治的81例SAP患者分为对照组(n=40)和观察组(n=41)。对照组予以乳酸钠林格注射液行早期液体复苏治疗,观察组在对照组基础上给予羟乙基淀粉130/0.4氯化钠注射液治疗,2组均持续治疗24 h。比较2组血液净化时间、机械通气时间,治疗前后膀胱压、炎性因子水平、血流动力学指标。结果 观察组血液净化、机械通气时间短于对照组(P<0.05或P<0.01)。治疗12 h、24 h后,2组膀胱压低于治疗前,且观察组低于对照组(P<0.05或P<0.01)。治疗24 h后,2组血清白介素-6(IL-6)、白介素-8(IL-8)水平低于治疗前,且观察组低于对照组(P<0.01)。治疗24 h后,2组胸腔内血容积指数(ITBVI)、中心静脉压(CVP)高于治疗前,肺血管通透性指数(PVPI)、血细胞比容(HCT)低于治疗前,且观察组升高/降低幅度大于对照组(P<0.05P<0.01)。结论 SAP患者在早期液体复苏治疗中应用羟乙基淀粉联合乳酸钠林格注射液能够有效抑制炎性反应,改善血流动力学,降低膀胱压,促进疾病快速恢复。

羟乙基淀粉对短暂性脑缺血发作手术患者的疗效及安全性分析

目的对于短暂性脑缺血发作行颈动脉手术治疗的患者,围手术期应用羟乙基淀粉40氯化钠,评价其有效性及安全性。方法选取2020年1月至2022年1月住院治疗的因颈动脉狭窄致脑缺血发作患者70例为研究对象,随机分为治疗组和对照组,每组35例,2组患者的一般情况差异无统计学意义(P>0.05)。治疗组分别于术前3 d及术后7 d给予羟乙基淀粉氯化钠注射液(500 ml,1次/d)治疗,对照组只给予患者和治疗组一样的基础治疗(扩血管及抗血小板聚集、抗凝等),分别于7 d、14 d观察2组患者的治疗效果、不良事件发生、外周血炎性因子(IL-6、IL-10、TNF-α)及凝血功能指标变化。结果2组患者NIHSS/GCS量表评分较治疗前均改善,且治疗组NIHSS/GCS评分较同期对照组改善明显,差异均有统计学意义(P<0.05),治疗后患者的外周血IL-6、TNF-α均低于治疗前,IL-10水平则高于治疗前,治疗组的指标变化幅度高于对照组(P<0.05),术后随访2组患者凝血功能改变无统计学差异(P>0.05)。2组患这围手术期不良事件发生无统计学差异(P>0.05)。结论羟乙基淀粉40氯化钠可用于因颈动脉狭窄致短暂性脑缺血发作的围手术期治疗,可显著改善患者低灌注症状,降低炎症反应,同时凝血功能并无显著变化,具有一定的安全性。

阿替普酶联合羟乙基淀粉治疗缺血性脑卒中的疗效分析

目的探讨缺血性脑卒中患者采用羟乙基淀粉与阿替普酶联合治疗的临床价值。方法246例缺血性脑卒中患者,随机分为对照组和观察组,每组123例。两组均进行常规治疗,对照组给予阿替普酶治疗,观察组在对照组基础上运用羟乙基淀粉联合治疗。比较两组治疗效果、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及血清学指标。结果治疗后3、7、14 d,观察组NIHSS评分分别为(15.09±3.45)、(4.12±1.78)、(2.01±0.44)分,均明显低于对照组的(17.68±5.34)、(9.11±3.09)、(4.56±2.11)分,差异有统计学意义(P<0.05)。观察组治疗总有效率91.06%高于对照组的73.17%,差异有统计学意义(P<0.05)。治疗后,观察组可溶性肿瘤坏死因子相关性凋亡诱导配体(sTRAIL)和骨保护素(OPG)水平分别为(67.23±10.09)、(108.23±34.23)ng/L,均明显低于对照组的(92.09±15.67)、(143.25±27.56)ng/L,差异有统计学意义(P<0.05)。结论临床运用羟乙基淀粉联合阿替普酶治疗缺血性脑卒中患者,能够减轻神经功能损伤,促进治疗效果的提高,值得推广。

6%羟乙基淀粉130/0.4对骨折创伤兔子血清白蛋白、微血管白蛋白渗漏、炎性因子的影响

目的:探讨6%羟乙基淀粉(HES)130/0.4对骨折创伤兔子血清白蛋白、微血管白蛋白渗漏、炎性因子的影响。方法:将20只健康雌性大白兔随机分为模型组和HES组,各10只,均采用钝器敲打后肢造成后肢骨折,行骨折切开内固定术。术后,模型组注射10 m L/kg生理盐水,HES组注射10 m L/kg 6%HES 130/0.4,连续3 d。比较两组血清白蛋白水平、微血管白蛋白渗漏情况以及白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)水平。结果:术后72 h,两组血清白蛋白水平低于术前,但HES组高于模型组,差异有统计学意义(P<0.05);HES组肠系膜微血管白蛋白渗漏率低于模型组,差异有统计学意义(P<0.05);两组血清IL-6、CRP以及PCT水平高于术前,但HES组低于模型组,差异有统计学意义(P<0.05)。结论:骨折创伤兔子术后存在血清白蛋白水平下降、炎性因子水平升高情况,给予6%HES 130/0.4治疗可以减小血清白蛋白降低幅度,下调IL-6、CRP以及PCT水平,改善白蛋白渗漏情况。