中分子羟乙基淀粉对脓毒性休克病人胃粘膜灌注的影响

目的观察中分子羟乙基淀粉（130／0.4）对脓毒性休克病人胃粘膜灌注的影响。方法收集20例脓毒性休克病人．按照2004年脓毒性休克治疗指南中的复苏目标，用中分子羟乙基淀粉（130，0．4）进行液体复苏。观察复苏前、后血流动力学指标、动脉乳酸浓度（ABL）和局部二氧化碳压力差（Pg-aCO2），即胃粘膜和动脉血二氧化碳压力差。结果中分子羟乙基淀粉（130／0．4）复苏后，Pg-aCO2从15．49mmHg降至11．72mmHg（P〈0．01），PAWP、CI、SVRI、DO2及ABL等指标升高（P〈0．01）；Pg-aCO2与ABL呈显著正相关性（r=0．546，P〈0．05），而与CI、DO2、VO2无显著相关性；中分子羟乙基淀粉（130／0．4）复苏前后。血清肌酐、PT、APTT和血小板无明显变化（P〉0．05）。结论中分子羟乙基淀粉（130/0．4）能改善脓毒性休克病人胃粘膜的灌注，对肾功能和凝血功能无明显影响。

Influence of hydroxyethyl starch on gastric mucosal perfusion of patients with septic shock

Objective To observe the effect of gastric mucosal perfusion of hydroxyethyl starch(130/0.4)to septic shock. Methods Selected 20 patients with septic shock, according to the resuscitation goals of therapy guideline on septic shock, practice fluid resuscitation with hydroxyethyl starch(130/0.4). Hemodynamics, artery blood lactate concentration and the partial pressure of carbon dioxide gap(Pg-aCO2), which is difference betweenPgCO2 and PaCO2, were observed before and after fluid resuscitation. Results After fluid resuscitation with hydroxyethyl starch(130/0.4), Pg-aCO2 decreased from 15.49mmHg to 11.72mmHg(P<0.01),PAWP, CI, SVRI, DO2 and artery blood lactate concentration rised(P<0.01), PVRI decreased(P<0.01); moreover, Pg-aCO2 and ABL had significant correlation(r=0.546, P<0.05). Pg-aCO2 was no related to CI, DO2 and VO2; There were no notable change(P>0.05) in blood Cr, PT, APTT and blood platelet no matter fluid resuscitation. Conclusion Hydroxyethyl starch(130/0.4)improves gastric mucosal perfusion of patients with septic shock, and has no side effect on renal function and coagulatin.