高渗氯化钠羟乙基淀粉40对联合硬膜外-腰麻下子宫全切术中恶心呕吐的防治  

The prevention of hypertonic sodium chloride hydroxylethyl starch 40 acute hypervolume hemodilution on the hysterectomy patient′s nausea and vomiting under combined spinal-epidural anesthesia

作　　者：吕志瑞[1] 姜丽华[1] 

机构地区：[1]郑州大学第三附属医院麻醉科,郑州451000

出　　处：《医学信息（手术学分册）》2007年第1期7-9,共3页Medical Information Operations Sciences Fascicule

摘　　要：目的观察高渗氯化钠羟乙基淀粉40.6％中分子羟乙基淀粉130／04急性高容量血液稀释对联合硬膜外-腰麻下子宫全切术中恶心呕吐的防治效果。方法选择择期行子宫全切术，ASAⅠ～Ⅱ级的病人45例，随机分成三组，每组15例。Ⅰ组为高渗氯化钠羟乙基淀粉40；Ⅱ组万汶；Ⅲ组乳酸格林氏液。三组患者分别于腰麻前20min内静脉输注高渗氯化钠羟乙基淀粉40、万汶、乳酸格林氏液250ml，均采用丁卡因（1％丁卡因1ml＋10％GS 1ml＋3％麻黄素1ml）重比重液2．5ml行腰麻．腰麻后低血压持续超过3min者，静注麻黄素10mg，比较三组腰麻后低血压、恶心、呕吐等的发生率及麻黄素应用率。结果Ⅰ、Ⅱ组低血压、恶心、呕吐的发生率、麻黄素应用率均明显低于Ⅲ组（P〈0．05），经快速补液后低血压的自动复升率Ⅰ，Ⅱ组明显高于Ⅲ组（P〈0．01），Ⅰ组低血压、恶心、呕吐的发生率、麻黄素应用率略低于Ⅱ组，但无统计学意义（P〉0．05）。结论以高渗氯化钠羟乙基淀粉40、万汶急性高容量血液稀释可有效防治联合硬膜外-腰麻下子宫全切术中恶心呕吐的发生．且高渗氯化钠羟乙基淀粉40的效果略优于万汶。Objective To investigate the effect of acute hypervolume hemodilution （AHH）with hypertonic sodium chloride hydroxylethyl starch 40 on the hysterectomy patient＇s nausea and vomiting under combined spinal - epidural anesthesia. Methods Forty - five ASA Ⅰ or Ⅱ patients aged 40 - 55 years weighing 44 - 65 kg undergoing hysterectomy under combined spinal - epidural anesthesia were randomized into 3 groups（n = 15 each）. Within 20 minutes pre -spinal anesthesia, those in group Ⅰ （n = 15 ）received 250 ml of hypertonic sodium chloride hydroxylethyl starch 40, those in group Ⅱ （ n = 15 ） 250 nd of voluven, and those in group Ⅲ （ n = 15 ） 250 ml of lactated Ringer＇s solution （LR）. Spinal anesthesia was performed with 10 mg of 1 g/L tetracaine hyperbaric soloution in all patients. Hypotension lasting 〉 3 minutes was treated with Ⅳ bolous of ephedrine 10 mg . The incidences of spinal hypotension, nausea and vomiting and the use of ephedrine were compared in the three groups. Results The incidences of spinal hypotension, nause and vomiting and event such as the administration oepbedrine in group Ⅰ and Ⅱ were significantly lower than those in group Ⅲ （P 〈 0.05 ）. The hypotension recovered faster in group Ⅰ and Ⅱ than in group Ⅲ （ P 〉 0. 05 ） through acute hypervolume hemodilution. The group Ⅰ is more superior to group Ⅱ. Conclusions The AHH with hypertonic sodium chloride hydroxylethyl starch 40 and voluven can effectively prevent the hysterectomy patient＇s nausea and vomiting under combined spinal - epidural anesthesia. Then hypertonic sodium chloride hydroxylethyl starch 40 is more superior to voluven.

关 键 词：高渗氯化钠 羟乙基淀粉 血液稀释 腰麻 恶心呕吐 

分 类 号：R713.42[医药卫生—妇产科学]