羟乙基淀粉与聚明胶肽用于全麻开胸手术中进行急性高容量血液稀释的对比研究  

Comparative Study of Polygeline and Hydroxyethyl Starch for Acute High-volume Hemodilution in General Anesthesia of Thoracic Surgery

作　　者：杨付星 施冬生[2] 

机构地区：[1]浙江松阳县人民医院麻醉科,浙江松阳323400 [2]浙江省中医院麻醉科,杭州310006

出　　处：《中国药房》2015年第3期319-321,共3页China Pharmacy

摘　　要：目的:比较羟乙基淀粉与聚明胶肽用于全麻开胸手术中进行急性高容量血液稀释(AHH)的效果及安全性。方法:选取择期行全麻开胸手术患者120例,随机均分为A、B两组。在行全麻开胸手术前,A组患者输注聚明胶肽注射液,B组患者输注羟乙基淀粉(130/0.4)氯化钠注射液,剂量均为15 ml/kg,进行AHH。比较两组患者AHH前、完成时、完成后30 min的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)变化,以及术前(D0)、术后第1天(D1)、术后第3天(D3)、术后第7天(D7)的白介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α变化,并观察两组患者的不良反应。结果:两组患者AHH前、后MAP均无显著变化(P>0.05);HR在AHH完成时均有下降,且B组患者下降更显著(P<0.05),而在AHH完成后30 min均恢复至正常;CVP在AHH完成后30 min仍均显著高于同组AHH前(P<0.05)。两组患者IL-6在D1时与D0比较均显著上升(P<0.05),D3和D7时呈明显下降趋势,但仍高于同组D0时(P<0.05),且B组患者IL-6均显著低于A组术后同时点(P<0.05);A组患者IL-8、TNF-α术后亦有显著上升(P<0.05),D7时降回至术前水平(P>0.05),而B组患者IL-8、TNF-α在术后持续下降,与同组D0和A组术后同时点比较差异均有统计学意义(P<0.05)。B组患者不良反应发生率显著低于A组,两组比较差异有统计学意义(P<0.05)。结论:羟乙基淀粉与聚明胶肽用于全麻开胸手术中进行AHH均可使患者血流动力学保持相对稳定,但羟乙基淀粉可以更有效地抑制炎症反应,且安全性更好。OBJECTIVE： To compare the effect and safety of polygeline and hydroxyethyl starch for acute high-volume hemodi- lution （AHH） in general anesthesia of thoracic surgery. METHODS： 120 patients underwent selective general anesthesia of thoracic surgery were selected and randomly divided into group A and B. Before surgery, group A was given Polygeline injection 15 ml/kg, and group B was given Hydroxyethyl starch （130/0.4） sodium chloride injection 15 ml/kg for carrying out AHH. The hemodynamics indicators as HR, MAP and CVP were compared between 2 groups before AHH, at the end of AHH and 30 min after AHH. The levels of IL-6, IL-8 and TNF-α were compared between 2 groups before surgery （D0）, at first day （D1）, third day （D3） and seventh day （D7） after surgery. ADR of 2 groups were also observed. RESULTS： MAP of 2 groups had no significant difference before and after AHH （P〉0.05）. HR of 2 groups decreased at the end of AHH, especially in group B （P〈0.05）, while those of 2 groups recovered to normal 30 min after AHH. CVP of 2 groups 30 min after AHH still were significantly higher than before AHH （P〈0.05）. Compared with Do, IL-6 of 2 groups at D1 increased significantly （P〈0.05） ; those of 2 groups decreased significantly at D3 and D7, which were still higher than tat at D0（P〈0.05） ; IL-6 of group B was lower than that of group A at same time points after surgery（P〈0.05）. The levels of IL-8 and TNF-α in group A increased significantly after surgery （P〈0.05）, and those of group A at D7 decreased to previous level before surgery （P〉0.05） ; those of group B decreased continuously after surgery; there was statistically significant difference at Do and between group B and A at same time points after surgery （P〈0.05）. The incidence of ADR in group B was significantly lower than in group A, and there was statistically significant difference （P〈0.05）. CONCLUSIONS： Polygeline and hydroxyethyl starch used for AHH in general anesthesia of

关 键 词：聚明胶肽 羟乙基淀粉 全麻开胸手术 急性高容量血液稀释 

分 类 号：R614[医药卫生—麻醉学]