四川省江油市人民医院四川 江油621700
目的：
通过羟乙基淀粉在术前贫血病人的术中应用，倍特倍希（羟乙基淀粉200/0.5氯化钠注射液Hydroxyethyl starch 200/0.5 and Sodium Chloride Injection），以期为羟乙基淀粉在纠正贫血，扩充血容量，补偿失血代偿提供新的理论依据。
方法：
1.选取2017.年10月至2018年5月在四川省江油市人民医院术前贫血并且行手术治疗，却未达到输血标准的46名患者，随机分为晶体治疗组23名（晶体组）和胶体参与治疗组23名（胶体组），并对两组患者性别、年龄、贫血程度、手术时间长短及术中失去血量进行分类比较。
2.预计术中失血量，计算术中补液量。根据体重以及禁食时间长短、手术时间长短、手术部位等等，计算生理需要量以及术中总输液量。在手术第一个小时输入1000ml晶体液，根据胖瘦可加减300ml。手术第二个小时可以按晶胶体比值为2:1混合输入。手术第三个小时，或者出血量短时间内达到400ml以上的患者，晶胶体按1:1混合输注。
3.选择输注液体及调整输液速度。晶体组，晶体液以林格氏液为主，生理盐水和葡萄糖液为辅助。胶体组，胶体液以倍特倍希（羟乙基淀粉200/0.5氯化钠注射液Hydroxyethyl starch 200/0.5 and Sodium Chloride Injection）为主，倍特倍希（羟乙基淀粉130/0.4氯化钠注射液Hydroxyethyl starch 130/0.4 and Sodium Chloride Injection）为辅。胶体组在输注晶体液的基础上加用羟乙基淀粉作为胶体补充剂。胶体液不允许超过总补液量的1/3.
4.容量调整。遵循及时、快速、足量的原则，根据尿量、心率，动脉血压及出血速度及出血量等指标调整输液速度，追加或者减少输液量。比如，连续2小时出现尿少时，则予以晶体液快速输注，并加快输液速度10%。当尿量超过2ml/kg/h时，输液速度则相应减少10%，当患者出现低血压（MAP小于70mmHg）和/或心动过速（HR大于120bpm）时，通过输入晶体液和加快输液速度不能纠正患者的少尿状态时，可以仅用胶体液复苏。胶体液匀速输注。
5.比较两组患者在术后24小时和术前24小时的血红蛋白，红细胞比积以及体重的变化。
6.计算数据以均数±标准差（x±s）表示，采用SPSS11.5统计软件进行数据处理和分析。p﹤0.05表示差异有统计学意义。
结果：
1.晶体组和胶体组患者的基本情况比较无显著性统计学差异（p＞0.05）。
2.术后24小时内，晶体组和胶体组输注的液体量分别为5000ml±1000ml和3000ml±500ml，体重增加分别为2.05±0.65Kg和1.55±0.80Kg。p﹤0.05差异有统计学意义。
3.手术24小时后，晶体组和胶体组的血红蛋白增加和红细胞比积增加分别为0±10g/l和10±5g/l。p﹤0.05差异有统计学意义。
结论：
1.胶体组患者的液体量明显少于晶体组患者。
2.胶体组患者的体重增加小，组织水肿轻。
3.胶体组患者在术后血红蛋白以及红细胞比积的增加上比较显著，晶体组无明显改变。可见胶体液对于术前贫血的患者有一定的纠正作用。
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关键词：术中补液；纠正贫血；羟乙基淀粉
Application of hydroxyethyl starch in the correction of anemia
Purpose:
Through the surgical application of hydroxyethyl starch in preoperative anemia patients, 倍特倍希(羟乙基淀粉200/0.5氯化钠注射液Hydroxyethyl starch 200/0.5 sodium chloride injection), with a view to correcting hydroxyethyl starch in anemia and expanding blood volume, Compensation for loss of blood provides a new theoretical basis.
Method:
1. Select 46 patients who had preoperative anemia and performed surgical treatment at the People's Hospital of Jiangyou City, Sichuan Province from October 2017 to May 2018, but did not meet the blood transfusion standards, and were randomly divided into 23 crystal therapy groups(crystal groups) and colloidal participation. Treatment group 23(colloidal group), The sex, age, degree of anemia, length of operation and loss of blood were classified and compared between the two groups.
2. To estimate the amount of blood loss during surgery and calculate the amount of fluid in surgery. According to the weight and fasting time, the length of the operation, the place of the operation, etc., the physiological requirements and the total amount of intraoperative infusion are calculated. Enter 1000ml crystal solution in the first hour of the operation, which can be added or subtracted by 300ml according to fat and thin. The second hour of the operation can be mixed with a ratio of 2:1 in the colloidal ratio. In the third hour of surgery, or in a short period of time with a bleeding volume of more than 400ml, the colloidal body presses a 1:1 mixed infusion.
3. Select the infusion fluid and adjust the infusion speed. In the crystal group, the crystal liquid is dominated by Ringer's liquid, assisted by physiological saline and glucose liquid. In the colloidal group, the body fluids are dominated by倍特倍希（羟乙基淀粉200/0.5氯化钠注射液 Hydroxyethyl 200 / 0.5 and Sodium Chloide Injection, and倍特倍希（羟乙基淀粉130/0.4氯化钠注射液 Hyroxyethyl stostyl 130/0.4/Slodex.
4. Capacity adjustment. According to the principle of timely, rapid, and sufficient amount, according to the urine volume, heart rate, arterial blood pressure and bleeding rate and the volume of bleeding , etc., adjust the infusion speed, add or reduce the infusion amount. For example, when urine occurs for 2 hours in a row, the crystal fluid is quickly injected and the infusion speed is accelerated by 10 %. When the urine volume exceeds 2ml/kg/h, the infusion speed is reduced by 10 %. When the patient has hypotension(MAP less than 70 mmHg) and/or tachycardia(HR greater than 120 BPM), When the patient's less urine state can not be corrected by entering crystal fluids and accelerating infusion speed, recovery can be done with only glue fluids. Glue fluid homogenization infusion.
5. To compare the changes of hemoglobin, erythrocyte ratio and body weight in the two groups after 24 hours of operation and 24 hours before operation
6. The calculated data is represented by an average ± standard deviation(X ± s), and SPSS11 .5 statistical software is used for data processing and analysis. P< 0.05 indicates that the difference is statistically significant.
Result:
1. There was no significant statistical difference between the basic conditions of the crystal group and the colloidal group(P﹥0.05).
2. Within 24 hours after surgery, the liquid content of the crystal group and the colloid group was 5000ml ± 1000ml and 3000ml ± 500ml, and the weight gain was 2.05 ± 0.65 Kg and 1.55 ± 0.80 Kg, respectively. The difference of P < 0.05 is statistically significant.
3. After 24 hours of surgery, the hemoglobin increase and the erythrocyte specific product increase in the crystal group and colloid group were 0 ± 10g/l and 10 ± 5g/l, respectively. The difference of P < 0.05 is statistically significant.
Conclusion:
1. The amount of liquid in the colloid group was significantly less than that in the crystal group.
2. The body weight gain of colloid group patient is small, tissue edema is light.
3. The increase of hemoglobin and erythrocyte in the gel group was significant, and there was no significant change in the crystal group. It can be seen that colloidal fluids have a certain corrective effect on patients with preoperative anemia.
Key words: intraoperative fluid supplementation; (a) To correct anaemia; Hydroxy ethyl starch
论文作者:史耐云 梁耘 王军文指导老师：衡孝伶
论文发表刊物:《医师在线》2018年5月上第9期
论文发表时间:2018/8/20
标签：胶体论文; 乙基论文; 晶体论文; 淀粉论文; 患者论文; 氯化钠论文; 注射液论文; 《医师在线》2018年5月上第9期论文;