不同配比HES 130/0.4电解质注射液在老年肝癌患者肝部分切除术前 急性高容量血液稀释中的应用

目的:评估不同配比HES 130/0.4电解质注射液在老年肝癌患者肝部分切除术前行急性高容量血液稀释（acute hypervolemic hemodilution，AHH）的效果。方法:选取2016年1月至2016年12月就诊于西安交通大学第一附属医院拟行肝部分切除术的老年男性患者45例，将其随机分为A组、B组和C组，每组15例。术前30 min 三组患者分别以HES 130/0.4电解质注射液10 mL/kg、乳酸钠林格注射液5 mL/kg+HES 130/0.4电解质注射液5 mL/kg、乳酸钠林格注射液10 mL/kg行AHH。术中监测患者心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）、中心静脉压（central venous pressure，CVP）。于AHH前（T0）、AHH开始后10 min（T1）、AHH开始后20 min（T2）、AHH结束即刻（T3）、AHH后1 h（T4）、AHH后2 h（T5）以及手术结束即刻（T6）采血样监测凝血功能；在T0、T3及T6采血样监测血栓弹力图（thromboela-stogram，TEG）参数及Na+、K+、Ca2+、Cl－水平。同时记录术中出血量、尿量、输血量及输液量，随访记录术后24 h腹腔引流量。结果:AHH后，与T0时比较，A、B两组MAP在T3之后显著升高，三组CVP在T4之后显著升高（P<0.05）。A组术中输血量及输液量显著少于B、C组（P<0.05）。与T0比较，A、B两组PT、APTT在T3后均明显延长，大于同时间点C组；FIB水平在T4后显著降低，低于同时间点C组；血栓弹力图R值在T6时明显升高，高于同时点C组（P<0.05）。与T0时比较，B、C两组K+浓度在T6时显著减低，且明显低于同时间点A组（P<0.05）。结论:术前应用HES 130/0.4电解质注射液行AHH对机体血流动力学、凝血功能、电解质水平等无明显不良影响，可安全应用于老年患者肝切除术中，有效减少异体血输入量。

Application of different proportions of HES 130/0.4 electrolyte injection in acute hypervolemic hemodilution before partial hepatectomy for elderly patients with liver cancer

Objective:To evaluate the effects of preoperative acute hypervolemic hemodilution (AHH) with different proportions of HES 130/0.4 electrolyte injection on circulation,coagulation and electrolyte in partial hepatectomy for elderly patients with liver cancer.Methods:Forty-five elderly men scheduled for partial hepatectomy in the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to December 2016,were averagely divided into group A,group B and group C according to the random number table.Thirty minutes before the surgery,patients of the three groups were immediately given AHH treatment with 10 mL/kg HES 130/0.4,5 mL/kg lactate ringer's solution + 5 mL/kg HES 130/0.4 and 10 mL/kg lactate ringer's solution,respectively.Heart rate (HR),mean arterial pressure (MAP) and central venous pressure (CVP) were detected during the operation.Immediately before AHH (T0),10 min following AHH (T1),20 min following AHH (T2),at the end of AHH (T3),1 h after AHH (T4),2 h after AHH (T5) and at the end of the surgery (T6),blood samples were collected for the determination of coagulation indexes.At T0,T3 and T6,blood samples were collected to determine the parameters of the thromboelastogram (TEG) and serum Na+,K+,Ca2+ and Cl- levels.The intraoperative volumes of blood loss,urine,blood transfusion and fluid,and the 24 h abdominal drainage fluid after operation were recorded.Results:After the AHH treatment,MAP of group A and group B after T3,and CVP of these three groups after T4 were markedly increased compared with those at T0 (P<0.05).The volumes of blood and liquid transfusion in the group A were distinctly less than that in the group B or group C (P<0.05).Compared with that at T0,APTT and PT of both group A and group B were significantly prolonged after T3,longer than that of the group C at the same time point.FIB level of the group A and group B was distinctly decreased after T4,lower than that of the group C at the same time point.R value of the group A and group B was markedly increased at T6,higher than that of the group C (P<0.05).Compared with that at T0,potassium concentration of the group B and group C was markedly decreased and significantly lower than that of the group A at T6 (P<0.05).Conclusion:Preoperative AHH with HES 130/0.4 electrolyte injection showed no harmful effect on hemodynamics,coagulation and electrolyte balance.It can be safely used in hepatectomy for elderly patients and effectively reduce the decrease the transfusion of allogenic blood.