缩合葡萄糖氯化钠注射液在肝肿瘤手术行急性高容性血液稀释的临床研究

目的：观察缩合葡萄糖氯化钠注射液行急性高容性血液稀释（AHH）对肝肿瘤手术病人血流动力学、凝血功能的影响。方法：肝肿瘤手术患者30例，随机分为对照组（I组，n=15），研究组（II组，n=15）。麻醉诱导后分别输入林格氏液和缩合葡萄糖氯化钠注射液行扩容治疗（15ml／kg），扩容速度50ml／min。在AHH前、AHH完毕、AHH完毕后30min记录HR、SBP、DBP、CVP、SPO2并检测红细胞比容（Hct）、血红蛋白计数（Hb）、血小板计数（Plt）和血浆凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（TT）及血浆纤维蛋白原（FIB）。结果：两组HR、SBP、DBP平稳，CVP在AHH完毕和AHH完毕30rain时增高（P〈0．01），组间无差异（P〉0．05）。Ⅰ组Hot、Hb、Plt在AHH完毕时明显下降（P〈0．05），30min后恢复（P〉0．05）。Ⅱ组Het、Hb、Plt在AHH完毕时下降显著（P〈0．05或P〈0．01），Hct、Hb30min后仍降低（P〈0．05），但Pit30min后恢复（P〉0．05）。Ⅰ组PT在AHH完毕时延长（P〈0．05），FIB显著减少（P〈0．01），但两者30min后恢复（P〉O．05）。Ⅱ组PT在AHH完毕时明显延长（P〈0．01），FIB明显减少（P〈0．01），30min后仍未能恢复（P〈0．05）。两组TT和APTT无明显变化。结论：缩合葡萄糖氯化钠注射液在肝肿瘤手术病人行急性高容性血液稀释，可以有效地维持术中循环功能的稳定，但部分病人CVP增高或PT延长及血浆FIB减少。

The effect of acute hypervolemic hemodilution with polyglucoside chlorinated natrium in patients undergoing hepatic tumor operation

Objective：To observe the influence of acute hypervolemic hemodilution （AHH） with polyglucoside chlorinated natrium solution （PGCS） on circulation, hemorhedogy and coagulation in patients undergoing hepatic tumor operation. Methods ：Thirty patients undergoing hepatic tumor operation were randomly divided into two groups： Control group （LRS） was infused with lactated ringer solution 15ml/kg; the test group （PC, CS） was infused with polygluceside chlorinated natrium solution 15ml/kg. In both group LR or PC, C solution was infused at a rate of 50ml/ rain after anesthesia induction. HR,SBP,DBP,CVP,Hb,Hct,Plt,PT,Tr,APTT,FIB were recorded respectively before AHH,after AHH and 30 minutes later. Results： There were no significant changes in BP and HR（P 〉0.05）but CVP increased significantly after AHH in both group （P 〈0.01 ）. In LRS group,Hct,Hb ,Plt decreased after AHH （P 〈 0.05）, but reached normal levels at 30 minutes later. In PGCS group, Hct and Hb significantly decreased after AHH（P 〈 0.01 ） but still lower than normal levels （P 〈 0.05） 30 minutes later. Pit decreased after AHH（P 〈 0.05） and reached normal levels at 30 minutes later. In LRS group, PT prolonged（P 〈0. 05） and FIB significantly decreased （P 〈 0.01 ） after AHH, but reached normal levels 30 minutes later. In PGCS group, PT significantly prolonged （P 〈0.01 ） and FIB significantly decreased （P 〈 0.01 ）after AHH, but still prolonged or decreased markedly compared with those before AHH at 30 minutes later. （ P 〈 0.05 ）. However, TT and APTT maintained stable in all patients. Conclusion： Polyglucoside chlorinated natrium solution （PGCS） can significantly improve hemorhedogy and is benefical to the microcirculatory perfusion. But CVP increased or PT prolonged and FIB decreased markedly in some patients.