中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (21): 3981-3984.doi: 10.3969/j.issn.1673-8225.2010.21.044

• 生物材料学术探讨 biomaterial academic discussion • 上一篇    下一篇

改良明胶和羟乙基淀粉130/0.4输注冠状动脉旁路移植患者：麻醉诱导早期扩容效果的比较

张  瑜，薛玉良，王洪武   

  1. 天津医科大学心血管病临床学院麻醉科，天津市  300457
  • 出版日期:2010-05-21 发布日期:2010-05-21
  • 通讯作者: 薛玉良，硕士，主任医师，硕士生导师，天津医科大学心血管病临床学院麻醉科，天津市 300457 xueyuliang@hotmail.com
  • 作者简介:张 瑜★，女，1983年生，汉族，天津市人，天津医科大学心血管病临床学院麻醉科在读硕士，主要从事心血管麻醉方面研究。 47504383@qq.com

Anesthesia-induced early-stage volume expansion effects of hydroxyethyl starch 130/0.4 versus modified fluid gelatin in patients undergoing coronary artery bypass graft

Zhang Yu, Xue Yu-liang, Wang Hong-wu   

  1. Department of Anesthesia, Cardiovascular Clinic College, Tianjin Medical University, Tianjin   300457, China
  • Online:2010-05-21 Published:2010-05-21
  • Contact: Xue Yu-liang, Master, Chief physician, Master’s supervisor, Department of Anesthesia, Cardiovascular Clinic College, Tianjin Medical University, Tianjin 300457, China xueyuliang@hotmail.com
  • About author:Zhang Yu★, Studying for master’s degree, Department of Anesthesia, Cardiovascular Clinic College, Tianjin Medical University, Tianjin 300457, China 47504383@qq.com

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摘要：

背景：临床迫切需要了解不同类型胶体溶液对于重症患者和麻醉关键时期的扩容效果及寻找适合临床应用的简易评估方法。
目的：测定分析定量液体输入前后血浆胶体渗透压和血红蛋白的动态变化，依据质量守恒原理建立方程估测血管内容量，比较麻醉诱导后羟乙基淀粉130/0.4和琥珀酰明胶的扩容效果。
方法：选择30例择期行冠状动脉旁路移植术的患者，采用常规麻醉及诱导，于诱导后10 min内分别输注7 mL/kg羟乙基淀粉130/0.4或琥珀酰明胶。分别于输注前，输注后即刻，输注后1 h，测量血红蛋白浓度，红细胞压积，胶体渗透压和平均动脉压。而后通过公式计算得出3个时间点的血管内容量(V(0)，V(1)，V(2))，两个时点的扩张容量(V△1，V△2)和即刻扩容比V△1/V(infusion)等指标。
结果与结论：两组组间比较各时点平均动脉压变化差异无显著性意义(P > 0.05)，两组组内比较液体输注后测定容量明显超过输液前，V(1) > V(0)(P < 0.05)。而且两组即刻扩容比 V△1/V(infusion)均大于100%，但组间差异无显著性意义(P > 0.05)。输液1 h后测定容量与输液后即刻(V(2)与V(1))相比，琥珀酰明胶组内差异无显著性意义(P > 0.05)，羟乙基淀粉130/0.4组内V(2) > V(1) (P < 0.05)。以上结果说明羟乙基淀粉130/0.4和琥珀酰明胶具有相似的强大的即刻扩容能力，输注后均可实现血管外液体向血管内的转移，但在胶体输注后1 h，羟乙基淀粉130/0.4的容量维持效应稍优于琥珀酰明胶，但无临床显著血流动力学变化差异。

关键词: 羟乙基淀粉, 琥珀酰明胶, 胶体渗透压, 容量, 麻醉诱导

Abstract:

BACKGROUND: The understanding of volume expansion effect of different colloid solutions in critical ill patient or during crucial period of anesthesia is immediately needed.
OBJECTIVE: To analyze the dynamic changes of colloid osmotic pressure and hemoglobin concentration before and after colloid solution infusions, to establish setting equations and estimate intravascular volume according to principle of conservation of mass, and to compare the effect of hydroxyethyl starch 130/0.4 and modified fluid gelatin on volume expansion early after induction.
METHODS: Thirty patients scheduled for coronary artery bypass graft, received either 7 mL/kg hydroxyethyl starch 130/0.4 or 7 mg/kg modified fluid gelatin within 10 minutes after induction. Colloid osmotic pressure, hemocrit, hemoglobin concentration and mean artery pressure were measured at 3 time points: before colloid fluid infusion, immediate after infusion and 1 hour after infusion. Intravascular volume (V(0), V(1), V(2)), expanded blood volume (V△1, V△2) and volume expansion rate (V△1/V(infusion)) immediately after colloid fluid infusion were calculated by equations.
RESULTS AND CONCLUSION: There was no significant difference of mean artery pressure between groups at each time point (P > 0.05). V(1) > V(0) in both groups (P < 0.05). V△1/V(infusion) was higher than 100% in both groups (P < 0.05), however, no difference of V△1/V(infusion) was found between groups (P > 0.05). V(1) and V(2) was comparable in modified fluid gelatin group (P > 0.05), however V(2) was higher than V(1) in hydroxyethyl starch 130/0.4 group (P < 0.05). The results above demonstrate that both hydroxyethyl starch 130/0.4 and modified fluid gelatin have a strong immediate volume expansion ability, as well as produced a shift of solution from extravascular space to intravascular space, but hydroxyethyl starch 130/0.4 has a slightly greater volume persistence than modified fluid gelatin, however this slight difference does not significantly affect the hemodynamic feature of both groups.

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