6%羟乙基淀粉130/0.4对患者硬膜外复合全麻诱导期肺循环的影响

Objective To observe the effect of pulmonary circulation by 6% hydroxyethyl starch 130/0.4 during induction period from epidural block combined with general anesthesia. Methods Twenty-six hepatobiliary surgical patients with ASA Ⅰ-Ⅱ, aged 32 y-59 y, weighing 54 kg-73 kg, were randomized into 2 groups(n=13): hydroxyethyl starch 130/0.4 group(HS)and complex acetic acid Ringer's solution (RL). Above-mentioned solutions were infused 7 ml/kg respectively before induction. The pulmonary circulation hemodynamic parameters such as pulmonary arterial systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure(MPAP), pulmonary artery wedge pressure(PAWP), pulmonary vascular resistance(PVR) and right ventricular stroke work(RVSW) were recorded at base value(T0), 10 min after infusion(T1), 5 min after induction(T2), 5 rain after intubation(T3), 10 rain after intubation(T4)and 20 min after intubation(T5). Results PASP、PADP、MPAP、PAWP and CVP were significantly higher in group HS at T, than the values at T0 (P<0.05); PVR in group HS was obviously lower from T1 to T5 than the value at To (P<0.05 or P<0.01); RVSW was significantly higher in two groups at T1 than base value (P<0.05), but that in group HS was lower than base value (P<0.05 or P<0.01); HR obviously decreased in two groups from T2 to T5 as compared with the value at T0 (P<0.05); MAP was lower from T3 to T5 than the value at To (P<0.05 or P<0.01). PVR was obviously lower in group HS from T1 to T5 than that in group RL (P<0.05 or P<0.01); MAP obviously increased from T2 to T5 in group HS as compared with the value in group RL(P<0.05 or P<0.01). Conclusion 6% hydroxyethyl starch 130/0.4 can obviously reduce PVR during induction pe-riod from epidural block combined with general anesthesia. In all, there is no effect on pulmonary circulation by 6% hydroxyethyl starch 130/0.4.     

比较不同分子量羟乙基淀粉对术中血液循环及凝血功能的影响

目的多中心、双盲、平行对照比较术中输注国产6%羟乙基淀粉200/0.5(6%HES200/0.5,盈源)和6%羟乙基淀粉130/0.4(6%HES130/0.4,万汶)对术中血流动力学、血液流变学及凝血功能的影响。方法150例择期手术的患者随机均分为Y组和V组。手术开始后,Y组输注6%HES200/0.51000ml,V组输注6%HES130/0.41000ml。分别于麻醉前(T0)、输注开始时(T1)、输注开始后30min(T2)、60min(T3)、90min(T4)、120min(T5)各时点监测患者血流动力学参数,在麻醉前及输注结束后10min抽血检测凝血功能及血液流变学参数。结果与T0时相比,两组患者T1时MAP均明显下降(P<0.05),V组T4、T5时MAP明显降低(P<0.05);T3时V组HR增快(P<0.05),输液结束后两组凝血酶原时间(PT)及部分凝血酶原时间(APTT)均有所延长(P<0.05),纤维蛋白原下降(FIB)(P<0.05),血小板计数(Plt)减少(P<0.05),但两组组间差异无统计学意义;两组液体均可降低全血高、低切变率(P<0.05),对血浆粘度无明显作用。两组术中输血量及晶体输入量差异无明显统计学意义。结论输入6%HES200/0.5或6%HES130/0.41000ml均可有效维持血流动力学稳定,改善机体微循环,但对凝血功能均有尚可耐受的影响。     

Vergleichende Untersuchung von niedermolekularem Dextranoder Hydroxyäthylstärkelösungen als Volumenersatzmittel bei Hämodilutionstherapie

Summary Rheological therapy, as an immediate treatment in conjunction with physical therapy and the removal of risc factors, plays a significant role in the management of patients with peripheral vascular disease experiencing reduced walking tolerance. An essential element of rheological therapy is hemodilution. Currently, is still uncertain which plasma substitute solution would be the most appropriate in such cases. This study compared the effectiveness of low molecular hydroxyethyl starch to low molecular dextran during a 16-day hemodilution in combination to physical therapy. The clinical improvement observed with both plasma substitute solutions was comparable, yet in view of the cardiac volume overload, dextran demonstrates greater circulatory stress due to the transient pressure increase and more side effects. For this reason, we prefer to administer low or middle molecular hydroxyethyl starch in the dilution treatment of peripheral arterial occlusive disease as a chronic degenerative vascular disease.

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Abkürzungen A2M Alpha-2-Makroglobulin - D0 Meßzeitpunkt 0 der später mit Dextran behandelten Gruppe - D1 Meßzeitpunkt 1 der Dextran-Gruppe - D2 Meßzeitpunkt 2 der Dextran-Gruppe - Dextran 40 kleinmolekulares Dextran (mittleres Molekulargewicht 40000 Dalton) - ETA Plasmaviskosität - Fib Fibrinogen - Geh Gehstrecke - H0 Meßzeitpunkt 0 der später mit Hydroxyäthylstärke behandelten Gruppe - H1 Meßzeitpunkt 1 der HAES-Gruppe - H2 Meßzeitpunkt 2 der HAES-Gruppe - HAES 40 kleinmolekulare Hydroxyäthylstärke (mittleres Molekulargewicht 40000 Dalton) - Hkt Hämatokrit - LZ Leukozyten-Zahl - Pro Gesamteiweiß - SEA Erythrozyten-Aggregationsindex - SER Erythrozyten-Rigiditätsindex - TY Fließschubspannung - TZ Thrombozyten-Zahl     

6%羟乙基淀粉急性高容血液稀释对围术期肺癌患者凝血功能的影响

目的 用6％羟乙基淀粉（hydroxyethyl starch，HES）溶液行急性高容血液稀释（acute hypervolemic hemodilution，AHHD），观察其对肺癌患者围手术期凝血功能的影响。方法择期行肺癌根治术患者40例，随机分为2个组：6％羟乙基淀粉（HES）组和对照组（每组20例）。HES组麻醉前快速输注6％HES（15ml／kg，于30min内），术中的失血量用等量的HES溶液补充，其余的液体需要量用乳酸钠林格氏液（RL）补充。对照组仅输注RL，不实施AHHD。检测输注液体前（T1）、手术开始后5min（T2）、术毕30min（T3）、术后6h（T4）时的血栓弹力图参数反应时间（R）、凝血时间（K）、α角（ANG）、最大振幅（MA）以及凝血酶原时间（PT）、激活的部分凝血活酶时间（APTT）、凝血酶时间（TT）、血小板数目（PLT）。结果HES组：T2、T3、T4时的ANG、MA均低小于对照组；T2、T3、T4时的凝血时间、PT、APTT、TT均长于对照组（P〈0．05或P〈0、01）；T2、T3、T4时的PLT均低于对照组（P〈0．05或P〈0、01）。HES组T3、T4时的各项凝血指标与T1时比较无明显差异（P〉0.05）；对照组：T3、T4时的ANG、MA均大于T1时；凝血时间、PT、APTT、TT均短于T1（P〈0．05或P〈0．01）。2组的失血量比较无统计学差异。结论 用6％HES行AHHD对围术期肺癌患者能产生一定的抗凝效果，这对本来就存在凝血功能亢进的肿瘤患者的预后及康复有积极意义。     

阿托伐他汀钙联合羟乙基淀粉注射液治疗分水岭脑梗死的临床效果研究

目的分析阿托伐他汀钙联合羟乙基淀粉注射液对分水岭脑梗死患者急性期和远期临床治疗效果。方法选取本院2013年2月至2014年6月收治的分水岭脑梗死患者78例为研究对象,采用随机数表法将其分为观察组和对照组,每组各39例,两组患者均给予稳压、降糖、抗血小板聚集等常规治疗,对照组患者在此基础上加用阿托伐他汀钙,观察组患者给予阿托伐他汀钙联合羟乙基淀粉注射液,比较两组患者急性期和远期的临床效果。结果治疗后7天,观察组患者日常生活能力和神经功能恢复均明显优于对照组(P<0.05);治疗后3个月,观察组患者神经功能及日常生活能力恢复均明显优于对照组,且治疗总有效率明显高于对照组(χ2=7.47,P<0.01)。结论阿托伐他汀钙联合羟乙基淀粉注射液在分水岭脑梗死患者急性期和远期均有较好的临床治疗效果。     

Hydroxyethyl starch is an alternative washing solution for peripheral bloodstem cells products

Cryopreservation of hematopoietic stem cells (HSC) involves slow rate cooling in the presence of a cryoprotectant (DMSO) to avoid the damaging effects of intracellular ice formation. The infusion of DMSO with the thawed product has been related to adverse events. Reduction of DMSO content by washing the HSCs after thawing has been suggested as a method to avoid infusion-related side-effects. Albumin-dextran washing methods have proved useful in thawing HSC products. Dextran40 shortages prompted us to search for suitable alternatives. We report the results of a comparative study of the use of hydroxyethyl starch (HES) as an alternative to dextran40 for washing thawed HSCs products. A total of 10 HSC bags cryopreserved with 10 % DMSO were used. We conducted a paired study; one of the bags was thawed and washed with our standard washing solution (Dextran 40) and the paired bag with HES solution with a final HES and Human Serum Albumin (HSA) concentration of 2.4 % and 4.2 % respectively. Each final product was tested immediately after washing (sample 0’) and after 90 min (sample 90’) for total nucleated cells (TNC) recovery, acridine orange viability, viable CD34+ enumeration, and clonogenicity. No significant difference was found for any of the cell counts, viability tests, cell recovery, or potency. We can state that the washing solution based on 2.4 % HES and 4.2 % HSA is equivalent to that used in our routine practice. Therefore, we could use the solution with HES, paying special attention to the renal function of the recipient.     

羟乙基淀粉注射液致急性肾损伤的危险因素分析

目的 探讨羟乙基淀粉注射液致急性肾损伤（AKI）的危险因素,为临床安全用药提供参考。方法 回顾性分析2015年1月—2019年3月衡水市人民医院86例羟乙基淀粉注射液致AKI和同期使用羟乙基淀粉注射液但未发生AKI的767例患者的临床资料,采用单因素（χ²检验）及多因素（Logistic回归）对肾毒性危险因素进行分析。结果 AKI是羟乙基淀粉注射液严重不良反应之一,发生率为10.08%。单因素分析显示,体重指数、低蛋白血症、肌酐清除率、合并肾毒性药物、术中出血量、日剂量和用药时间与羟乙基淀粉肾毒性相关;多因素分析显示,日剂量（≥14 mL/kg）、肌酐清除率（<30mL/min）、用药时间（≥5 d）、术中出血量（>3 000 mL）、合并肾毒性药物和低蛋白血症（ALB<30 mL/L）是羟乙基淀粉130/0.4氯化钠注射液致AKI的独立危险因素。所有患者停药或经相关治疗后肾功能均逐渐恢复。结论 日剂量偏大、肾功能不全、长时间用药、术中出血量偏大、合并肾毒性药物和低蛋白血症是羟乙基淀粉致AKI的独立危险因素,临床中重点关注有独立危险因素的患者,以保证临床安全用药。     

中分子羟乙基淀粉联合小剂量尿激酶治疗急性脑分水岭梗死的疗效观察

目的 观察中分子羟乙基淀粉联合小剂量尿激酶治疗急性脑分水岭梗死（CWI）患者的临床疗效.方法 68例CWI患者随机分为两组,对照组（n=34）在常规治疗措施基础上加用小剂量尿激酶,观察组（n=34）在常规治疗措施基础上加用中分子羟乙基淀粉、小剂量尿激酶联合治疗.比较两组治疗总有效率,治疗前后神经功能缺损程度（NIHSS）和Barthel指数变化情况.结果 观察组治疗总有效率（88.24％）明显高于对照组（67.65％） （x2=7.383,P＜0.05）;两组患者治疗前NIHSS、Bar-thel比较差异无统计学意义（P＞0.05）,随治疗时间延长,NIHSS逐渐降低,Barthel逐渐升高,且观察组降低和升高较对照组更为显著（P＜0.05）;两组治疗期间未见严重不良反应发生.结论 中分子羟乙基淀粉联合小剂量尿激酶治疗CWI疗效显著,可明显改善神经功能缺损程度和日常生活能力,值得临床推广应用.     

Investigations on metabolism and carcinogenicity of 1,1,2-trichloroethane

Summary Two groups of male and female Sprague-Dawley rats (50 animals/group per sex) were treated with either 15.37 or 46.77 mole of 1,1,2-TCE in DMSO/rat for 2 years. The animals were treated once a week by s.c. injection of test compound in the skin of neck. Two groups of controls received either DMSO or no treatment at all. The incidence of benign mesenchymal and epithelial tumors was not significant when compared with either DMSO-treated or untreated controls. The animals treated with 46.77 mole 1,1,2-TCE significantly developed sarcomas when compared with the untreated controls. In a further experiment, either 40 mole or 160 mole 1,1,2-TCE was injected into male Wistar rats and the metabolites, TdGA and HEMA, were determined in 24-h urine samples. Comparative studies were carried out giving equimolar amounts of chloroethanol and 2-chloroacetaldehyde diethyl acetal. Analysis of the metabolites showed that no detectable HEMA was excreted in urine after treatment of rats with 1,1,2-TCE or chloroethanol. TdGA was excreted in urine much more among chloroacetaldehyde-treated animals than among 1,1,2-TCE- or chloroethanol-treated rats.Abbreviations 1,1,2-TCE 1,1,2-trichloroethane - DMSO dimethyl-sulfoxide - Hema hydroxyethyl mercapturic acid - TdGA thiodiglycolic acid     

高渗晶胶复合液静脉补液在犬烧伤早期防治休克疗效观察

目的研究应用高渗晶胶复合液快速静脉补液对35%TBSA烧伤犬伤后早期休克的防治作用及对血流动力学的影响。方法 Beagle犬12只,采用凝固汽油燃烧法制作Ⅲ度烧伤面积35%TBSA模型,随机分为常规补液组(A组)和高渗补液组(B组)。A组按照4ml/(kg.1%TBSA)输入乳酸钠林格氏液,在前8h输入总量的一半,B组采用高渗氯化钠羟乙基淀粉40注射液,按照8ml/kg快速补液后终止补液。分别于伤前、伤后1h、2h、4h、6h、8h进行血流动力学检测,测定各组犬的胸腔内血容量指数(ITBI)、血管外肺水量(EVLW)、血容量(PV)及血浆渗透压。结果烧伤后两组ITBI均呈逐步降低趋势,B组经高渗补液后,伤后1h其ITBI降低与A组相比差异无统计学意义(P0.05),至伤后2h开始明显降低,4h后显著低于A组,两组相比差异有统计学意义(P0.05);A组EVLW显示伤后渗出增多,而B组经高渗补液,EVLW显示伤后2们h内血管外渗出较伤前差异无统计学意义(P0.05),渗出量显著低于A组,两组相比差异有统计学意义(P0.05);伤后A组PV明显降低,B组经高渗补液,PV在伤后1、2、4h降低缓慢,且PV明显高于A组,两组相比差异有统计学意义(P0.05),伤后4h后PV迅速减少,并显著低于A组,两组相比差异有统计学意义(P0.05);伤后A组血浆渗透压有所降低,B组经高渗补液,血浆渗透压在伤后1、2h较伤前增高,且显著高于A组(P0.05),两组相比差异有统计学意义,伤后4h后逐步降低,至伤后8hB组显著低于A组,两组相比差异有统计学意义(P0.05)。结论烧伤早期快速静脉补充高渗晶胶复合液,在4h内能够有效维持血流动力学指标稳定,并减少组织渗出,从而起到大大减少补液量、节约医疗资源、降低并发症、提高复苏疗效的作用,适于危重烧伤早期院外现场急救。