羟乙基淀粉130／0.4和高渗氯化钠羟乙基淀粉40联合扩容在肝癌切除术中的应用

摘要

目的：探讨在肝癌手术中联合使用羟乙基淀粉130/0.4注射液（Voluven）或高渗氯化钠羟乙基淀粉40注射液（HSH40）扩容对患者血压、凝血酶原时间（PT）的影响及节约异体输血的安全性和有效性。方法将择期行肝癌切除术的60例患者随机分为HSH40联合乳酸钠林格液组（HR组）以及HSH40联合Voluven组（HV组）各30例。HR组麻醉诱导前静脉滴注HSH40，术中予乳酸钠林格液维持中心静脉压；HV组麻醉诱导前静脉滴注HSH40，术中辅助使用Voluven液维持中心静脉压。记录和比较两组患者总失血量、输液量、需输血例数、尿量、手术时间以及术前和术毕的平均动脉压（MAP）、PT和钠离子浓度。结果两组的总失血量、手术时间比较差异无统计学意义（P＞0.05）。HV组的输液量、需输血例数均少于HR组（P＜0.05）。HV组的尿量多于HR组（P＜0.05）。两组MAP、PT及钠离子浓度的术前术后及组间比较差异均无统计学意义（P＞0.05）。结论肝癌切除术中联合应用Voluven和HSH40可安全有效地增加循环储备，减少红细胞丢失，增强患者对于失血的耐受力，减少异体血的输注量，起到有效的血液保护作用。%Objective To investigate the safety and effectiveness of hydroxyehtyl starch1 30/0.4 (Voluven)combined with hypertonic sodium chloride hydroxylethyl starch40 (HSH40)for maintaining blood pressure,prothrombin time and conservation of allogeneic transfusion in hepatectomy. Methods Sixty patients who would receive elective hepatectomy were randomly divided into HR group (n=30)and HV group (n=30). HR group received HSH40 injection before induction of general anesthesia,and Ringer's solution was used to maintain central venous pressure in operation;HV group received HSH40 injection before induction of general anesthesia,and voluven solution was used to maintain central venous pressure in operation. The volume of hemorrhage,infusion quantity,blood transfusion,urine and the time of operation and were recorded and compared between two groups during operation. The mean arterial pressure,prothrombin time and Na+were re-corded and compared at the time pre-operation and the end of operation. Results Volume of hemorrhage and the time of operation between the two groups were not statistically significant (P>0.05 ). The volume of infu-sion quantity and the cases received blood transfusion of HV group were significantly less than those of HR group (P<0.05 ). The volume of urine of HV group was significantly higher than that of group HR group (P<0.05 ). There were no statistical difference of MAP,PT and Na+between two groups (P>0.05 ). Conclu-sion Voluven combined with HSH40 can be safely used in hepatectomy.This method can reduce red blood cell loss and allogeneic blood transfusion,enhance the patients resistance for blood loss,and play an effective role of blood conservation.