不同手术方式时高渗氯化钠羟乙基淀粉40注射液对血气的影响

目的术中给予高渗氯化钠羟乙基淀粉40注射液（高渗晶胶液）与琥珀酰胺明胶注射液和乳酸林格液对照,在开腹与气腹的手术中观察其对血气的影响。方法选择ASAⅠ或Ⅱ级气腹腹部手术病人45例,全麻插管后随机分为3组,A1组（n=15）,B1组（n=15）,C1组（n=15）。选择ASAⅠ或Ⅱ级开腹腹部手术病人45例,全麻插管后随机分为3组,A2组（n=15）,B2组（n=15）,C2组（n=15）。A组插管后输注高渗晶胶液4ml／kg,30min输完;B组输注琥珀酰胺明胶注射液8ml／kg,30min输完,C组插管后输注乳酸林格液500ml,按8ml／kg,30min输完。记录插管后输入前（T0）、输入后30min（T1）、60min（T2）、90min（T3）、120min（T4）的血气变化。结果在气腹手术中琥珀酰胺明胶注射液与高渗氯化钠羟乙基淀粉40注射液pH都有降低,高渗晶胶液T1时（P〈0．01）,T2、3（P〈0．05）,Be在T2时下降（P〈0．05）;琥珀酰胺明胶注射液pH值也有明显下降,T1（P〈0．01）,T2（P〈0．05）,Be无明显变化。而两种注射液在开腹的手术中则无此变化。乳酸林格液在开腹与气腹手术中均无变化。结论高渗晶胶液在气腹手术中有pH的下降。

Effects of hypertonic sodium chloride hydroxyethyl starch 40 injection on blood gas by different operation methods

Objective To observe the change of the patient＇ s blood gas when hypertonie sodium chloride hydroxyethyl starch 40 （ HSH40）, succinylated gelatin and lactate ringer＇ s solution were given separately during laparotomy and pneumoperitoneum lafaroscopy. Methods 45 patients ASA class Ⅰ or Ⅱ were perfomed pneumo- peritoneum lafaroscopy. They were divided into three groups A1 （ n = 15 ）, B1（ n = 15 ）, C1 （ n = 15 ） at random after general anesthesia. Another 45 patients of class Ⅰ or Ⅱ were performed laparotomy. They were divided into three groups A2 （ n = 15 ）, B2 （ n = 15 ） , C2 （ n = 15 ） at random after general anaesthesia. After general anesthesia, groups A： the HSH40 was injected in a dose of 4ml/kg in 30min. Groups B： the succinglated gelotin was injected in a dose of 8ml/kg in 30 min. Groups C： the lactate ringer＇ s solution were injected in a dose of 8ml/kg in 30 min. The blood gas were measured after inserting the pipe but before the injection （ To ） and after injection 30min （ T1 ）, 60min （T2 ）, 90min （ T3 ）, 120min （ T4 ）. Results During the pneumoperitoneum lafaroscopy operation, the pH value of blood gas went down after injection of HSH40 and succinglated gelotin. Groups A1 in the time T1 （ P 〈 0.01 ）, T2,3 （ P 〈 0.05 ）. Groups B1 in the time T1 （ P 〈 0. 01 ）, T2 （ P 〈 0. 05 ）. During the pneumoperitoneum lafaroscopy operation, the pH value of blood gas went down after injection of HSH40 in the time T2 （ P 〈 0. 05 ）, but Be had no variation after injection of succinglated gelotin. During the laparotomy, the PH or Be had no change. When lactate ringer＇ s solution was used, PH or Be had no variation. Conclusion pH value of blood significantly was reduced after injection of HSH40 by pneumoperitonum operation.