预注高渗氯化钠羟乙基淀粉40注射液对剖宫产妇凝血功能、电解质和血糖的影响  

Effect of preinfusing hypertonic saline hydroxyethyl starch 40 injection on clotting function,blood glucose and electrolyte levels in women after cesarean section

作　　者：郭素莲[1] 刘星[1] 张红梅[2] 马传根[1] 

机构地区：[1]河南大学淮河医院麻醉科,河南开封475000 [2]河南大学淮河医院检验科,河南开封475000

出　　处：《军医进修学院学报》2011年第8期822-824,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的探讨预注高渗氯化钠羟乙基淀粉40注射液(HSS40)对剖宫产妇凝血功能、电解质和血糖的影响。方法选择ASAⅠ-Ⅱ级、足月妊娠、择期在硬膜外麻醉下行剖宫产术产妇40例,随机分为高渗氯化钠羟乙基淀粉40注射液(H)组和复方乳酸钠(R)组。入手术室后H组以5ml/kg输注HSS40,R组以5ml/kg输注复方乳酸钠,30min输注完毕,60min后行硬膜外麻醉,分别在输注HSS40前(T0)、输注完毕即刻(T1)、30min(T2)、60min(T3),监测HR、MAP、SPO2、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、血小板功能(PF)、血清K、Na、Hct、Hb及血糖。结果与T0时比较,H组PT、APTT于T1时明显延长(P<0.05),Fib明显减少(P<0.05),T2时达高峰(P<0.05),T3时尚未恢复;R组PT、APTT、Fib各时点无明显变化(P>0.05),组间比较有明显差异(P<0.05)。与T0比较,H组T2时K+浓度有所降低,T3时基本恢复,Na+浓度T1时明显升高,随着血液稀释,T3时基本恢复至基础值;H组Hct、Hb各时点明显降低(P<0.05),组间比较差异显著(P<0.05);两组各时点血糖浓度无明显变化(P>0.05),循环均稳定。结论预注HSS40(5ml/kg)对凝血功能有影响,使PT、APTT延长,Fib降低,但在机体的代偿范围内,能减轻围术期产妇的高凝状态,对电解质及血糖无明显影响。Objective To study the effect of preinfusing hypertonic saline hydroxyethyl starch 40（HSS40） on clotting function,electrolyte and glucose levels in women after cesarean section.Methods Forty full-term women at ASAⅠ-Ⅱ after cesarean section at a selected time under epidural anesthesia were randomly divided into HSS 40 group（group H） and compound sodium lactate（CSL） group（group R）.Women in group H were infused with HSS40（5ml/kg） and those in group R were infused with CSL（5ml/kg） for 30 min when they were sent to the operation room.After 60min,HR,MAP,SPO2,PT,APTT,Fib,PF,and serum K,Na,Hct,Hb,as well as blood glucose were detected before infusion of HSS40（T0）,immediately after infusion of HSS40（T1）,30min after infusion of HSS40（T2）,60min after infusion of HSS40（T3）,respectively.Results The PT and APTT were significantly longer at T1 than at T0 in group H,while the Fib level was significantly lower which reached its peak at T2（P0.05） and did not return to its normal level at T3.No significant difference was observed in PT,APTT,and Fib of group R at different time points but a significant difference was found between the two groups（P0.05）.The K＋ level was lower at T2 than at T0 in group H and returned to its normal level at T3,while the Na＋ level was significantly higher at T1 and almost returned to its normal level at T3 with the diluted blood.The Hct and Hb levels were significantly lower in group H than in group R at different time points（P0.05）.No significant change was found in blood glucose level between the two groups at different time points（P0.05） with a stable blood circulation.Conclusion Preinfusion of HSS40 can prolong the PT and APTT,decrease the Fib level and alleviate the high coagulant state of parturients with but has no effect on electrolyte and blood glucose levels.

关 键 词：高渗氯化钠羟乙基淀粉40注射液 凝血功能 电解质 血糖 剖宫产 

分 类 号：R614[医药卫生—麻醉学]