全身热疗时6%羟乙基淀粉和复方乳酸钠的体液治疗作用

目的:观察6%羟乙基淀粉(HES)和复方乳酸钠(Ringer's)在晚期肿瘤患者全身热疗时对血流动力学和酸碱平衡的影响,为临床肿瘤全身热疗的体液治疗提供理论依据。方法:20例晚期肿瘤全身热疗患者,随机分为羟乙基淀粉(H)组和复方乳酸纳(R)组。在输注一定量葡萄糖的同时,H组输6%HES1500ml及Ringer's液,R组输6%HES500ml及Ringer's液。于麻醉前及升温到38.5℃、40℃、41.8℃、41.8℃2h和降温到40℃、38.5℃时,测定PH、PaCO2、BE、肺部干湿罗音,并持续测定MAP、HR、CVP、SPO2,术后计算出入量、西地兰、多巴胺和速尿用量。结果:随着体温升高,两组HR都明显增快,MAP明显下降,CVP逐渐增高,至40℃后,与术前比有显著差异(p<0.05或p<0.01),且R组的HR比H组快,MAP比H组低,CVP比H组高(p<0.05或p<0.01);恒温后,R组的CVP均高出正常范围。PH在恒温期明显降低,高温结束后逐渐恢复正常。恒温期两组PaCO2明显增高(p<0.05或p<0.01),组间比也有显著差异(p<0.05);至41.8℃及复温到38℃期间,BE值较术前明显降低(p<0.05)。复温时R组肺水肿的发生率、总输液量均高于H组(p<0.01)。结论:全身热疗时需要输入大量溶液,6%羟乙基淀粉的扩容效果好,可减少液体输入量,并有利于防止肺水肿和心衰。

The effect of 6% HES and Ringer''''s solution in tumour patients during Whole-body hyperthermia treatment

Objective To study the effects of 6% HES and Ringer's solution on the hemodynamic and acid-base balance in the tumour patients during Whole-body Hyperthermia(WBH) treatment.Methods Twenty tumour patients aged 32～68 was performed Whole-body Hyperthermia treatment.6% HES 1500ml was infused in the group H;6% HES 500ml was infused in the group R.The same volume of glucose solution and different volume of Ringer's solution between group H and group R was given to maintain a mid-normal MAP.Temperature,MAP,HR,CVP,SPO_2 were recorded continuously,pH,PaCO_2,BE,Lung's breath rale were measured before WBH,at Hyperthermia 38.5℃,40℃,41.8℃,41.8℃2h and at 40℃,38.5℃ in recovery. Results The HR and CVP increased,and MAP decreased continuously during WBH in both group(p<0.05 or p<0.01),pH and BE decreased,and PaCO_2 increased significantly continuously during WBH and during recovery period(p<0.05 or p<0.01),The changes were different between two groups during 41.8℃,41.8℃2h and at 40℃ period respectively(p<0.05 or p<0.01).Lung's breath rale appeared more in group R than in group H during recovery temperature, especially at 41.8℃2h and 40℃.The total fluid infusion was higher in group R than in group H(p<0.01).Conclusion 6% HES infusion is a better choice to prevent excess pulmonary fluid or edema in spite of 5-6L of fluid administered during the WBH treatment in tumour patients.