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目的探讨乳酸林格氏液和羟乙基淀粉130/0.4容量负荷治疗的效果。方法本研究为双盲前瞻性研究。选择2011年7月—2013年3月择期胃肠外科肿瘤手术患者81例,美国麻醉医生分级Ⅰ~Ⅱ,分成2组:Ⅰ组(羟乙基淀粉130/0.4容量负荷组,n=56)和Ⅱ组(乳酸林格氏液容量负荷组,n=25)。麻醉诱导后予以3次容量负荷,每次3 m L·kg?1羟乙基淀粉130/0.4或者乳酸林格氏液,7 min输毕。麻醉前后、每次容量负荷后稳定5 min,记录平均动脉压(MAP)、每博心脏输出量指数(SVI)、血容量扩张效率和氧供(DO_2)。结果麻醉诱导期间SVI和MAP均降低,两组相当;Ⅰ组和Ⅱ组患者对3次容量负荷的反应性分别为64%对20%(P<0.001)、43%对13%(P<0.001)和23%对14%(P=0.101);而第1或2次容量负荷后Ⅰ组患者达到容量最优化的累计比例低于Ⅱ组(25%对74%,P<0.001;46%对81%,P<0.001),第3次2组差异无统计学意义(88%对89%,P=0.825)。3次容量负荷后SVI上升的幅度Ⅰ组(基础值86%)高于II组(基础值68%)(P<0.001),而MAP变化2组差异无统计学意义。第1次负荷后2种液体的血容量扩张效率相当,第2次和第3次负荷Ⅰ组高于Ⅱ组。麻醉诱导和血液稀释均导致氧供下降,2种液体之间没有区别。结论容量优化治疗中胶体液的容量治疗效果优于晶体液,建议采用胶体液进行容量负荷治疗。
Objective To investigate the effect of Ringer’s lactate solution and hydroxyethyl starch 130 / 0.4 volume load therapy. Methods This study was a double-blind prospective study. A total of 81 patients undergoing elective gastrointestinal surgery from July 2011 to March 2013 were selected and divided into two groups: group Ⅰ (hydroxyethyl starch 130 / 0.4 volume load group, n = 56) And Group II (Ringer’s lactate volume load group, n = 25). After induction of anesthesia to 3 times the capacity load, each 3 m L · kg? 1 hydroxyethyl starch 130 / 0.4 or lactated Ringer’s solution, 7 min lose completed. Before and after anesthesia, each volume load was stable for 5 min, mean arterial pressure (MAP), cardiac output index (SVI), blood volume expansion efficiency and oxygen supply (DO 2) were recorded. Results Both SVI and MAP decreased during induction of anesthesia, which were comparable between the two groups. The response to volume load in group Ⅰ and group Ⅱ was 64% vs 20% (P <0.001), 43% vs 13% (P <0.001) ) And 23% vs 14% (P = 0.101). However, the cumulative volume-optimized patients in group I or group II after the first or second volume load were lower than those in group II (25% vs 74%, P <0.001; 46% vs 81%, P <0.001). There was no significant difference in the third group (88% vs 89%, P = 0.825). The magnitude of SVI increase after 3 volume loadings in group I (basal value 86%) was higher than that in group II (base value 68%) (P <0.001), but there was no significant difference in MAP changes between the two groups. After the first load, the blood volume expansion efficiencies of the two liquids were comparable, while the second and third loads were higher in group I than in group II. Both anesthesia induction and hemodilution lead to a decrease in oxygen supply, with no difference between the two fluids. Conclusions Volumetric treatment of colloidal fluid in capacity optimization treatment is better than that of crystalloid solution. It is recommended to use volumetric loading of colloidal fluid.