6%羟乙基淀粉130/0.4在创伤骨科患者血液稀释后血管渗漏的研究  

Research on vascular leakage of 6%hydroxyethyl starch 130/0.4 doing acute hemodilution in orthopedic patients

作　　者：曲玲燕 李杰 吴量 衣秀娜[1] 黄绍艳[1] 邵伟[1] 张建中[1] Qu Lingyan;Li Jie;Wu Liang;Yi Xiuna;Huang Shaoyan;Shao Wei;Zhang Jianzhong(Department of Anesthesiology,Yantaishan Hospital,Shandong Province,Yantai 264008,China)

机构地区：[1]山东省烟台市烟台山医院麻醉科,264008

出　　处：《中国综合临床》2020年第4期332-336,共5页Clinical Medicine of China

基　　金：山东省重点研发计划项目(2018GSF118054);烟台市科技计划项目(2019YD040)。

摘　　要：目的探讨6%羟乙基淀粉130/0.4(6%hydroxyethyl starch,HES)用于严重创伤骨科患者急性血液稀释后血管渗漏的发生情况。方法采用前瞻性队列研究方法选择2018年6月至2018年12月烟台市烟台山医院符合入选标准、择期行手术治疗的创伤骨科患者48例作为观察对象,美国麻醉医师协会(Amereican Society of Anesthesiologists,ASA)分级为Ⅰ~Ⅲ级。按创伤程度分为两组,即普通骨科患者组24例、严重创伤骨科患者组24例。按照血容量公式计算患者的血容量,两组患者气管插管后经静脉以0.5 ml/(kg·min)的速率输注10%血容量的HES行急性血液稀释。于急性血液稀释前即刻(T0)、急性血液稀释结束后15 min(T1)、30 min(T2)时测定血浆胶体渗透压和血红蛋白。测定T1、T2血浆HES浓度,保存输液开始至输液结束后30 min的尿量,测定尿量和HES浓度从而计算出尿中HES含量。结果普通骨科患者组和严重创伤骨科患者组患者输入HES的量相同,分别为(7.71±0.30)ml/kg和(7.70±0.20)ml/kg,扩容比例约为100%。与T0比较,普通骨科患者组血浆胶体渗透压在T1、T2时[(27.9±1.5)mmHg(1 mmHg=0.133 kPa)和(27.7±1.5)mmHg]高于T0[(26.5±1.5)mmHg,P<0.05];严重创伤骨科患者组血浆胶体渗透压在T1、T2[(27.0±1.6)mmHg和(26.9±1.5)mmHg]与T0[(26.3±1.7)mmHg,P>0.05]比较差异无统计学意义。严重创伤骨科患者组血浆HES浓度在T1、T2时[(6.8±0.6)g/L与(5.8±0.5)g/L]低于普通骨科患者组[7.7±0.5)g/L与(7.1±0.5)g/L,t值分别为5.660、6.755,P<0.05];输液后30 min内尿HES的含量普通骨科患者组与严重创伤骨科患者组分别为[(29.0±3.5)mg和(28.4±3.3)mg],两组比较差异无统计学意义(t=0.61,P>0.05)。结论两组患者HES行急性血液稀释扩容比例相同,血浆胶体渗透压和HES浓度在严重创伤骨科患者变化低,HES在严重创伤骨科患者存在更明显的血管外渗漏。Objective To explore the incidence of vascular leakage after acute hemodilution in patients with traumatic orthopedics by using 6%hydroxyethyl starch 130/0.4(HES).Methods Using prospective cohort study method,48 orthopedic trauma patients in in Yantaishan Hospital from June 2018 to December 2018 were selected as the subjects of observation.The American Society of anesthesiologists(ASA)grade was divided into grade I-III.According to the degree of trauma,they were divided into two groups:general orthopedic patients group(24 cases)and severe trauma orthopedic patients group(24 cases).According to the formula of blood volume,the blood volume of the patients in the two groups was calculated.After intubation,10%of the blood volume of HES was infused intravenously at the rate of 0.5 ml/(kg·min)for acute hemodilution.Plasma colloidal osmolality and hemoglobin were measured immediately before acute hemodilution(T0),15 minutes(T1)and 30 minutes(T2)after acute hemodilution.The concentrations of HES in T1 and T2 plasma were measured.The urine volume from the beginning of infusion to 30 minutes after the end of infusion was saved.The urine volume and hes concentration were measured to calculate the urine hes content.Results The amount of HES input was the same in the general orthopedic patients group and the severe trauma orthopedic patients group,which were(7.71±0.3)ml/kg and(7.70±0.2)ml/kg,and the expansion ratio was about 100%.Compared with T0,plasma colloid osmotic pressure at T1 and T2 were(27.9±1.5)mmHg(1 mmHg=0.133 kPa))and(27.7±1.5)mmHg in the general traumatic orthopedics patients,which was higher than T0((26.5±1.5)mmHg,P<0.05).There was no significant difference of COP at T1 and T2((27.0±1.6)mmHg and(26.9±1.5)mmHg)compared with T0((26.3±1.7)mmHg,P>0.05)in the severe trauma orthopedic patients).The concentration of plasma HES in the severe trauma orthopedic patients((6.8±0.6)g/L and(5.8±0.5)g/L)was lower than in the general traumatic orthopedics patients((7.7±0.5)g/L and(7.1±0.5)g/L,t=5.660 and 6.755,all

关 键 词：轻乙基淀粉 血液稀释 骨科 血管渗漏 

分 类 号：R687[医药卫生—骨科学]