赣南医学院学报2024，Vol.44Issue(2)：142-147,6.DOI:10.3969/j.issn.1001-5779.2024.02.006
高渗羟乙基淀粉行急性等容血液稀释对患者血流动力学、动脉血气及凝血功能的影响
The effect of acute normovolaemic hemodilution with hypertonic sodium chloride hydroxyethyl starch injection on hemodynamics,blood gas analysis and coagulation
摘要
Abstract
Objective:To investigate the effects of Acute normovolaemic hemodilution(ANH)with hypertonic sodium chloride hydroxyethyl starch 40 and hydroxyethyl starch 130/0.4 on hemodynamics,arterial blood gas and coagulation in patients undergoing lumbar fusion.Methods:Fifty patients undergoing lumbar fusion were randomly divided into hypertonic sodium chloride hydroxyethyl starch group(Hyperosmotic group)and hydroxyethyl starch 130/0.4 control group(Control group),with 25 cases in each group.The patients in hyperosmotic group were given hypertonic sodium chloride hydroxyethyl starch 40 injection with 0.5 times the volume of autologous blood collection,and those in control group were given hypertonic sodium chloride hydroxyethyl starch 40 injection with 0.5 times the volume of autologous blood collection.The same volume of autologous blood was infused with hydroxyethyl starch 130/0.4 sodium chloride injection,and the hematocrit of the two groups was controlled to 30%after hemodilution according to the Gross formula.Heart rate(HR)and mean arterial pressure(MAP)were recorded at 5 min before ANH(T1),10 min after the end of ANH(T2),5 min before autologous blood transfusion(T3)and 10 min after the end of blood transfusion(T4).Arterial blood gas analysis was performed at T1,T2 and T4,and thromboelastography was performed at T1 and T4.Intra-operative operation time,blood loss,allogeneic blood infusion volume,infusion volume,urine volume,use of vasoactive drugs and complications were monitored in the two groups of patients.Results:At time T3,the mean arterial pressure of patients in the hypertonic group was significantly lower than that of the control group,with a statistically significant difference(P＜0.05).There was no statistically significant difference in mean arterial pressure between the two groups at other time points(P＞0.05).There were 9 cases(36.0%)in the hypertonic group who used vasoactive drugs during surgery,and 2 cases(8.0%)in the control group,with a statistically significant difference(P＜0.05).The intraoperative urine output of patients in the hypertonic group was significantly higher than that of the control group,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in arterial blood gas analysis and thromboelastography parameters between the two groups of patients(P＞0.05).Conclusion:It is safe and feasible to use hypertonic sodium chloride hydroxyethyl starch 40 and hydroxyethyl starch 130/0.4 for mild acute normovolemic hemodilution in patients undergoing lumbar fusion surgery,which has a certain blood protection effect.During ANH,the volume monitoring and management should be strengthened according to the physical and chemical properties of different fluids.关键词
高渗氯化钠羟乙基淀粉/羟乙基淀粉130/0.4/急性等容血液稀释/血流动力学/血栓弹力图Key words
Hypertonic sodium chloride hydroxyethyl starch/Hydroxyethyl starch 130/0.4/Acute normovolemic hemodilution/Hemodynamics/Thromboelastography分类
医药卫生引用本文复制引用
王恩福,莫娇,李忆,吴志勇,胡志敏,卢枫,谢海玉..高渗羟乙基淀粉行急性等容血液稀释对患者血流动力学、动脉血气及凝血功能的影响[J].赣南医学院学报,2024,44(2):142-147,6.基金项目
江西省卫生健康委员会科技计划课题(SKJP220202889) （SKJP220202889）
赣州市指导性科技计划项目(GZ2021ZSF104) （GZ2021ZSF104）
