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目的探讨输注高渗氯化钠羟乙基淀粉40液(HSH40,霍姆)对妇科宫腔镜手术中患者胸腔液体含量变化的影响。方法选择行妇科宫腔镜手术的患者60例,随机分为高渗氯化钠羟乙基淀粉组(H组,n=30),6%羟乙基淀粉组(V组,n=30)。两组患者均在麻醉诱导平稳后自外周静脉预输注霍姆或羟乙基淀粉溶液5ml/kg,测定麻醉诱导前(T0)、霍姆或羟乙基淀粉溶液输注后即刻(T1)、输注后15min(T2)、手术结束时(T3)的心率、平均动脉压、中心静脉压、动脉血气分析的变化,用胸电生物阻抗法测定心输出量指数(CI)及胸腔液体含量(TFC)的变化。记录术毕24小时(T4)的呼吸情况。结果T1、T2时点两组中心静脉压、CI均较T0升高(p<0.05),且H组比V组升高明显(p<0.05)。T3时H组的TFC显著低于V组(p<0.01),且V组T3时点的TFC值显著高于T0时点(p<0.05)。T1、T2时点H组Na+均较T0升高(p<0.05),而V组无明显变化。各时点H组K+均降低(T1和T2 p<0.05,T3组p<0.01)。结论预输注高渗氯化钠羟乙基淀粉40液(HSH40,霍姆)能有效减少妇科宫腔镜手术中患者胸腔液体含量,预防肺水肿的发生。
Objective To investigate the effect of infusion of hypertonic sodium chloride hydroxyethyl starch 40 (HSH40, Homer) on the changes of fluid in the chest during gynecological hysteroscopic surgery. Methods Sixty patients undergoing gynecological hysteroscopic surgery were randomly divided into three groups: hypertonic sodium chloride hydroxyethyl starch group (H group, n = 30), 6% hydroxyethyl starch group (V group, n = 30) . Two groups of patients were pre-anesthetized induction of peripheral arterial blood or hepatic hydroxyethyl starch solution 5ml / kg before anesthesia induction (T0), Holm or hydroxyethyl starch solution infusion (T1) , Heart rate, mean arterial pressure, central venous pressure and arterial blood gas analysis after 15min (T2), T3 (T3), cardiac output index (CI) and pleural fluid content (TFC) changes. Record the end of surgery 24 hours (T4) of the respiratory situation. Results The central venous pressure and CI of both groups increased at T1 and T2 compared with T0 (p <0.05), and were significantly higher in group H than those in group V (p <0.05). The TFC of H group was significantly lower than that of V group (P <0.01) at T3, and the TFC of V group at T3 was significantly higher than that of T0 (p <0.05). At T1 and T2, Na + in H group was higher than that in T0 (p <0.05), while there was no significant change in V group. At each time point, K + of H group decreased (T1 and T2 p <0.05, T3 group p <0.01). CONCLUSION: Pre-infusion of hypertonic sodium chloride hydroxyethyl starch 40 (HSH40, Homer) can effectively reduce pleural fluid in gynecological hysteroscopic surgery and prevent pulmonary edema.