6%羟乙基淀粉130/0.4体外循环预充对心脏手术患儿血浆胶体渗透压及乳酸水平的影响

Objective To investigate the effects of hydroxyethyl starch 130/0.4 (HES) used as priming fluid for cardiopulmonary bypass (CPB) on the plasma colloid osmotic pressure (COP) and lactic acid (LAC) concentration in infants undergoing cardiac surgery.Methods Forty infants of either sex with age ≤6 yr undergoing cardiac surgery with CPB were randomly divided into 2 groups (n =20 each): HES group and control group. The left radial artery and the right internal jugular vein were cannulated for blood pressure (BP) and the central venous pressure (CVP) monitoring. Arterial blood gases, blood LAC concentration, hemoglobin (Hb), hematocrit (Hct), mean arterial pressure (MAP) and nasopharyngeal temperature were measured and recorded immediately before and 5 min after aortic cross-clamping, at the end of CPB and operation. Plasma COP was measured before induction of anesthesia (T1), at 5 and 30 min of CPB (T2 and T3, respectively), before routine ultra-filtration (T4), at the end of CPB (T5) and2 h in ICU (T6).Results The plasma LAC concentration was significantly lower and the COP significantly higher in HES group than in control group (P＜0.05 or 0.01).The plasma LAC concentration increased after aortic cross-clamping, reached the peak at the end of CPB and then declined at the end of operation, but was still higher than that before aortic cross-clamping in both groups. Plasma COP was significantly decreased during CPB as compared with the baseline at T1, but increased at T6 in both groups.Conclusion Using HES 130/0.4 as pdming fluid for CPB can effectively improve plasma COP and reduce blood LAC level in infants undergoing cardiac surgery with CPB.     

羟乙基淀粉130/0.4血液稀释对断指再植患者血液流变学和微循环的影响

目的:探讨羟乙基淀粉130/0.4高容量血液稀释对断指再植患者血液流变学和微循环的影响. 方法: 对40例ASA Ⅰ～Ⅱ患者随机分为万汶组(n=20)和对照组即平衡盐组(n=20),手术前扩容至Hct 30%. 麻醉方法均为肌间沟臂丛神经阻滞. 术中液体维持用平衡盐. 血管吻合开放血流后比较两组血运微循环情况,手术开始时和结束时检测血液流变学指标. 结果: 万汶组AHHD后全血低切黏度、高切黏度、红细胞比容、血小板黏附率明显低于对照组(P《0.05);血管吻合后微循环指标万汶组的毛细血管充盈时间明显低于对照组,SPO2高于对照组(P《0.05). 结论: 羟乙基淀粉130/0.4术前AHHD可以明显改善血液流变学状态,有利于微循环灌注,改善局部氧供,提高术中断指再植的成活.     

尼莫地平治疗脑梗死病人的疗效与多种血清酶变化

目的：探索尼莫地平治疗脑梗死病人的疗效及治疗前后多种血清酶的变化。方法：５２例脑梗死病人（男性２２例，女性３０例，年龄６７±ｓ９ａ），采用尼莫地平５０ｍＬ（１０ｍｇ）及羟乙基淀粉（７０６代血浆）５００ｍＬ，静脉滴注，ｑｄ×１５ｄ治疗；测定急性期和恢复期的７种血清酶（ＣＰＫ，ＬＤＨ，ＡＬＴ，ＡＳＴ，γ－ＧＴ，ＡＫＰ，Ａｍｙ－２）并以５２例同龄健康者作正常对照。结果：治疗１个疗程总有效率９２％。急性期（１～１０ｄ内）ＣＰＫ，ＡＳＴ明显增高，同恢复期及正常对照组比较，Ｐ值分别＜０．０１及＜０．０５；而γ－ＧＴ在急性期和恢复期的早期（发病３０～４０ｄ内）均高，同正常对照组比较，Ｐ＜０．０１。结论：尼莫地平加羟乙基淀粉治疗脑梗死疗效好，３种酶（ＣＰＫ，ＡＳＴ，γ－ＧＴ）的增高，对脑梗死病的诊断、治疗、预防提供了新的依据。     

6%羟乙基淀粉130/0.4对老年患者经尿道前列腺电切手术血浆渗透压及电解质K+、Na+、Cl-的影响

目的观察6%羟乙基淀粉130/0.4对老年经尿道前列腺电切术患者的血浆渗透压和电解质K 、Na 、C l-的影响。方法40例ASAⅠ~Ⅲ级行经尿道前列腺电切术老年患者随机分为羟乙基淀粉组(Ⅰ)和乳酸钠林格注射液组(Ⅱ);麻醉诱导开始45 m in内按10 m l/kg分别输注6%羟乙基淀粉130/0.4(Ⅰ)和乳酸钠林格注射液(Ⅱ),随后均用乳酸钠林格注射液维持容量;于输液前、手术30 m in和术毕取静脉血检测血浆渗透压和电解质K 、Na 、C l-,分别记录各组血流动力学指标、B超前列腺大小、术中冲洗液用量、手术时间、静脉输液总量。结果血浆渗透压变化Ⅰ组较Ⅱ组小,差异有显著性(P<0.01);K 变化两组比较差异无显著性,Na 、C l-变化Ⅰ组较Ⅱ组小,差异有显著性(P<0.05);术毕收缩压两组比较差异有显著性(P<0.05)。结论老年患者经尿道前列腺电切术术中应用6%羟乙基淀粉130/0.4,有利于维持机体内环境及血流动力学的平稳。     

Use of Sodium Hetastarch (Hespan) Solution for Reduction of Postoperative Adhesion Formation in Rabbits

A study was conducted to determine the effect of sodium hydroxy ethyl starch (Hespan) on primary adhesion formation in a rabbit model. Hespan is a readily available volume expander. This was a randomized, double-blinded animal model in which New Zealand white rabbits were subjected to midline celiotomy. Adhesions were created by abrasion in both uterine horns, adjacent bowel, and peritoneum. Necropsies were performed at the 2-week interval and adhesions were graded. Significant decreases in type II and type III adhesions (p =. 032 and p =. 020, respectively) were demonstrated in Hespan-treated animals. Sodium hetastarch appears to decrease signifcant adhesion formation in treated animais and may have a roie as an adjunct for postsurgical prevention.     

急性高容量血液稀释对肝癌手术病人内环境变化的影响

目的：探讨6%羟乙基淀粉液术前行高容量血液稀释（AHH）对肝癌手术病人内环境变化的影响。方法：ASA Ⅰ-Ⅱ级肝癌患者30例,随机分为试验组（H组）和对照组（C组）,其中H组麻醉诱导前快速输注贺斯15 ml·kg^-1,C组输注乳酸钠林格液,方法同H组。监测MAP、HR和CVP：记录术中出血量和输液量：分别于稀释前（T1）、稀释后即刻（T2）、术毕（T3）、术后第3 h（T4）进行血气分析及检测血清电解质。结果：PH、HCO2^-、BE在T2时间点H组均有所降低,与C组比较有有统计学意义（P〈0.05）;血清Na^＋在T2-T4时间点H组有轻度上升;C组在T2时间点下降,与C组比较有统计学意义（P〈0.05）：H组血浆K^＋在T2、T3时间点与C组比较有统计学意义（P〈0.05）;H组血浆Cl^-在T2时间点升高（P〈0.05）;两组Cl^-于T3、T4时间点均升高（P〈0.05）。结论：AHH对肝癌手术病人机体电解质及酸碱平衡具有一定影响。     

羟乙基淀粉130/0.4的药理特性及生理影响

羟乙基淀粉(hydroxyethy/starch,HES)具有最低的过敏反应发生率(约0.06%)和良好的扩容效果,在胶体溶液中受到重视。根据克分子置换(molar substi-tution,MS)和平均分子量(MW)不同,已投入使用的HES有HES450/0.7,HES200/0.62,HES200/0.5,HES70/0.5等。但由于它们对凝血功能和肾脏     

Global tissue oxygenation during normovolaemic haemodilution in young children

Sixteen patients (1–8 years) scheduled for major general surgery were chosen for the study. They were divided into two groups according to the replacement solution used for haemodilution (HD); whether 6% middle molecular weight hydroxyethyl starch (HES) or 6% dextran 60 (DEX). After induction of general anaesthesia and pulmonary artery catheterization, a precalculated amount of autologous blood was withdrawn while the patient's autologous blood was simultaneously replaced by either HES or DEX. Autologous blood was retransfused at a minimum haematocrit (Hct.) of 17% or at the end of surgery. The following parameters were measured and/or calculated before and after HD, every 20 min intraoperatively and hourly for 6 h postoperatively: heart rate (HR), mean arterial pressure (MAP), Cardiac index (CI), Hct., arterial and mixed venous oxygen content (CaO₂, CvO₂) and arterio-venous difference of oxygen content (avDO₂), oxygen delivery index (DO₂I), oxygen consumption index (VO₂I). The cardiovascular system remained stable. There was no significant difference as regards SvO₂, despite a significant decrease in CaO₂ to 10.8 and 10.0 ml·dl^?1 (median values) due to reduction of haemoglobin concentration in the HES and DEX groups respectively. In spite of the low hct. values during surgery DO₂I remained in normal range (median value 602 and 710 ml·min^?1·m^?2) in HEX and DEX group respectively. There was no significant change in VO₂I after haemodilution (median value 212 and 243 ml.min^?1·m^?2) in either group. No statistically significant difference was noticed between either groups regarding: CaO₂, CvO₂, DO₂I, VO₂I, and no side effects of the colloids were observed. Isovolaemic haemodilution (Hct. approx;17%) is well tolerated by young children undergoing major elective surgery; global tissue oxygenation was preserved throughout the procedure and both solutions used for haemodilution were equally effective.     

不同剂量6%羟乙基淀粉130/0.4预先给药对大鼠内毒素性急性肾损伤的影响

目的研究6%羟乙基淀粉(HES)130/0.4预先给药对大鼠内毒素性急性肾损伤的影响及其机制。方法48只SD♂大鼠随机均分为6组。对照组(C组):经尾静脉注射生理盐水(NS)30ml/kg;模型组(L组)和H1、H2、H3组:先分别经尾静脉注射NS30ml/kg、6%HES130/0.47.5、15、30ml/kg,1h后再经尾静脉注射内毒素(LPS)5mg/kg;H4组:经尾静脉注射6%HES130/0.430ml/kg。所有动物均0.2ml/min恒速给药。LPS注射4h后行动脉血气分析,放血处死动物。检测血清肿瘤坏死因子-α(TNF-α)、丙二醛(MDA)、超氧化物歧化酶(SOD)、尿素氮(BUN)、肌酐(Cr),观察肾组织病理学改变。结果与C组比较:L、H1、H2、H3组pH、PaO2降低,PaCO2、血清TNF-α、MDA、SOD、BUN、Cr水平升高(P<0.05);与L组比较:H1、H2、H3组PaO2升高,PaCO2降低(P<0.05);与L组比较:H1、H2组TNF-α、MDA水平降低,SOD水平升高,H3组BUN、Cr水平升高(P<0.05);与H3组比较:H1、H2组BUN、Cr水平降低(P<0.05),H2组TNF-α、MDA水平降低,SOD水平升高(P<0.05);C组与H4组各指标组间差异无统计学意义(P>0.05)。结论单独大剂量(30ml/kg)HES130/0.4对大鼠肾无明显损伤;中、小剂量(15、7.5ml/kg)预先使用HES130/0.4可改善内毒素性炎症反应,不加重肾损伤;大剂量(30ml/kg)可加重内毒素性大鼠急性肾损伤。     

6%羟乙基淀粉130/0.4与乳酸钠林格液麻醉前预扩容用于剖宫产手术的比较

目的比较乳酸钠林格液和6%羟乙基淀粉130/0.4用于剖宫产手术硬膜外麻醉前预扩容的效果及对产妇低血压、恶心和呕吐的影响。方法选择ASAⅠ-Ⅱ级剖宫产的产妇60例,随机分为乳酸钠林格液组(A组)和6%羟乙基淀粉130/0.4组(B组),每组30例。硬膜外麻醉前A组和B组分别在30min内输入乳酸钠林格液和羟乙基淀粉130/0.4 500ml。持续监测血流动力学变化;记录胎儿出生后的Apgar评分;观察产妇术中恶心、呕吐发生情况及麻黄素使用次数。结果两组产妇一般情况及其胎儿Apgar评分比较无显著性差异(P>0.05);在麻醉后15min、胎儿娩出时A组的平均动脉压(MAP)较基础值低,心率(HR)则较基础值高(P<0.05),而B组其各时点间MAP和HR比较无显著性差异(P>0.05);与A组比较,B组术中恶心、呕吐发生率及麻黄素使用次数明显降低(P<0.05)。结论 6%羟乙基淀粉130/0.4预扩容可以有效预防硬膜外麻醉后产妇低血压、恶心及呕吐的不良反应。