羟乙基淀粉和乳酸林格氏液对腹腔镜妇科手术患者多糖包被完整性的影响研究  

The effects of hydroxyethyl starch and lactated Ringer’s solution on the integrity of polysaccharide coating in patients undergoing laparoscopic gynecological surgery

作　　者：汪莹莹 张逢源 石力文 邓姣 路志红 WANG Ying-ying;ZHANG Feng-yuan;SHI Li-wen;DENG Jiao;LU Zhi-hong(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital,Air Force Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学第一附属医院麻醉与围术期医学科,陕西西安710032

出　　处：《实用医院临床杂志》2022年第5期25-28,共4页Practical Journal of Clinical Medicine

基　　金：国家自然科学基金资助项目(编号:81871028);白求恩基金项目(编号:BCF-RF-WSQZJZT-202011-021)。

摘　　要：目的 观察羟乙基淀粉(HES)和乳酸林格氏液(LR)输注对腹腔镜妇科手术患者多糖包被降解产物及术中术后恢复指标的影响。方法 选择择期在全身麻醉下行腹腔镜妇科手术患者64例,随机分为晶体组和胶体组(每组32例),分别采用乳酸林格氏液和乳酸林格氏液+羟乙基淀粉溶液进行预扩容和术中输注。测定输注前、输注60 min和手术结束时患者的血清多配体蛋白聚糖1(SDC-1)、透明质酸(HA)、硫酸乙酰肝素(HS)水平。记录术中血流动力学指标和术后恶心呕吐、饮水时间、排气时间、住院时间和主要并发症情况。结果 两组患者术前、术中、术后各时间点的SDC-1、HA和HS水平比较,差异均无统计学意义(P>0.05),但胶体组术中和术后SDC-1低于术前(P<0.05),胶体组术中HS较术前显著下降(P<0.05)。晶体组血清学指标在各时间点无显著变化(P>0.05)。两组患者血流动力学和术后恢复指标比较,差异无统计学意义(P>0.05)。结论 腹腔镜妇科手术患者输注羟乙基淀粉溶液比单纯输注乳酸林格氏液可能更有利于多糖包被的稳定,对于维持微循环的稳定可能有益。Objective To observe the effects of hydroxyethyl starch(HES) and lactated Ringer′s solution(LR) on the degradation products of glycocalyx and intraoperative and postoperative recovery indexes in patients undergoing laparoscopic surgery.Methods Patients scheduled for elective laparoscopic gynecological surgery under general anesthesia were selected. The patients were randomly divided into a crystalloid group and a colloid group, 32 in each group. The crystalloid group received pre-loading and intraoperative infusion with LR and the colloid group received LR + HES. Levels of serum syndecan-1(SDC-1), hyaluronic acid(HA), and heparan sulfate(HS) were measured before infusion, 60 min after infusion, and at the end of surgery. Intraoperative hemodynamic indicators such as systolic and diastolic blood pressures, heart rate and mean arterial pressure were recorded. Postoperative nausea and vomiting, time to drinking and flatus, postoperative hospital stay and major complications were compared between the two groups.Results There was no significant difference in the levels of SDC-1, HA and HS between the two groups at preoperative, intraoperative and postoperative time points, but at 60 min after infusion and at the end of surgery, syndecan-1 in the colloid group was significantly decreased when compared with that before operation(P<0.05), and heparan sulfate was significantly decreased at 60 min after infusion when compared with that before operative(P<0.05). There were no significant changes in the crystalloid group at each time point. There was no significant difference in hemodynamics and postoperative recovery indexes between the two groups(P>0.05).Conclusion Infusion of HES in patients undergoing laparoscopic surgery may be more beneficial for glycocalyx than LR, and thus may benefit the microcirculation.

关 键 词：多糖包被 腹腔镜手术 晶体液 胶体液 预扩容 

分 类 号：R246.2[医药卫生—针灸推拿学]