4%琥珀酰明胶溶液术前扩容对胃癌根治术患者血液高黏状态的改善作用

目的 观察4%琥珀酰明胶溶液(4% succinylated gelatin,GEL)术前扩容对胃癌患者围术期血液流变性的影响.方法 择期行胃癌根治术的40例患者,通过计算机产生的随机数分为2组(n=20),另选20例同期在本院行健康查体者作为正常对照.麻醉诱导时于30min内给2组患者分别输注15ml/kg GEL溶液(GEL组)或乳酸钠林格氏(ringer's lactated,RL)溶液(RL 组).分别于麻醉诱导前(T_0)、扩容结束后即刻(T_1)、扩容结束后1h(T_2)和手术结束后1 h(T_3)抽取静脉血,采用全功能自动血液流变仪检测全血黏度、血浆黏度、红细胞聚集指数(EAI)、纤维蛋白原和血细胞压积(Hct).结果 与正常对照组比较,胃癌组的全血低切黏度、全血中切黏度、全血高切黏度、血浆黏度、EAI、纤维蛋白原增加(P<0.05 .与T_0比较,GEL组T_1、T_2和T_3时全血黏度、血浆黏度、EAI、纤维蛋白原、Hct降低(P<0.05).与T_0比较,RL组T_1时全血黏度、血浆黏度、EAI、纤维蛋白原、Hct降低,(P<0.05),T_3时伞血低切黏度、红细胞聚集指数增加(P<0.05).与RL组比较,GEL组T_2和T_3时全血黏度、EAI、纤维蛋白原、Hct降低(P<0.05).结论 胃癌患者血液处于高黏状态,术前采用GEL溶液扩容能明显改善胃癌根治术患者围术期血液流变性、减轻高黏状态.

The ameliorating effect of preoperative loading infusion with 4% succinylated gelatin solution on hemorheology of gastric cancer patients during perioperative period

Objective To investigate the effect of loading infusion with succinylated gelatin(GEL) solution before surgery on hemorheology of patients with gastric cancer during perioprative period. Methods Forty patients undergoing gastric cancer radical surgery were randomly divided into 2 groups (n=20): GEL solution group (GEL group) and Ringer's Lactated solution group(RL group). Twenty people received health examination were selected as normal control group. The two kinds of solution were respectively infused at a dose of 15 ml/kg over a period of 30 rain before surgery (loading infusion, LI). Blood samples were taken for determination of hemorheology variables before LI(T_0, baseline), the end of LI(T_1), 1 h after the end of Ll(T_2)and 1 h after the end of surgery (T_3). Results The blood viscosity, plasma viscosity, erythrocyte aggregation index (EAI)and fibrinogen were higher than those in normal control group (P<0.05). The blood viscosity, plasma viscosity, EAI, fibrinogen and Hct decreased significantly as compared to the baseline values at T_0 in GEL group(P<0.05). The blood viscosity at low shear rate and EAI increased significantly as compared to the baseline values at T_0 in RL group (P<0.05). The blood viscosity, plasma viscosity, EAI, fibrinogen and Hct were lower than those in RL group at T_2 and T_3(P<0.05). Conclusion Blood of patients with gastric cancer presentes hyperviscosity state.GEL solution can ameliorate hemorheology variables and alleviate hyperviscosity state during perioperative period.