目的 评价6%羟乙基淀粉130/0.4电解质注射液用于脑膜瘤切除术患者液体治疗的效果。 方法 择期行脑膜瘤切除术患者92例，年龄18～64岁，ASA分级Ⅰ级或Ⅱ级，BMI 18～30 kg/m2，性别不限，预计手术时长>3 h。采用随机数字表法将患者分为2组(n＝46)：乳酸钠林格液组(LR组)和羟乙基淀粉组(HES组)。LR组全程静脉输注乳酸钠林格液，HES组静脉输注6%羟乙基淀粉130/0.4电解质注射液，最大剂量不超过50 ml/kg，超出部分以乳酸钠林格液补充。采用目标导向液体治疗，维持SVV<13%，MAP 70～90 mmHg。分别于麻醉诱导前即刻(T0)、液体输注1 000和2 000 ml(T1，2)时、术毕即刻(T3)行动脉血气分析，同时监测血栓弹力图。记录术中电解质紊乱、酸碱平衡失调、凝血功能异常的发生情况和去甲肾上腺素用量。术后3和7 d时随访，记录QoR-15评分。记录术后住院时间、脑水肿、肺水肿和恶心呕吐的发生情况。 结果 LR组和HES组分别有4例和6例因手术时间过长被排除，最终2组分别纳入42例和40例。与LR组比较，HES组T3时血浆Na＋浓度升高，T1-3时血浆Cl－浓度和pH值升高，T2，3时血浆Ca2＋浓度降低，T3时反应时间升高，T2，3时凝血时间升高，最大振幅降低，T1-3时凝固角降低(P<0.05)。2组均未发生电解质紊乱及凝血功能异常。2组术中去甲肾上腺素用量和碱中毒发生率、术后Qor-15评分、住院时间、肺水肿、脑水肿及恶心呕吐发生率比较差异无统计学意义(P>0.05)。 结论 相对于乳酸钠林格液而言，6%羟乙基淀粉130/0.4电解质注射液用于脑膜瘤切除术患者液体治疗的效果无差异。 Objective To evaluate the efficacy of 6% hydroxyethyl starch (HES) 130/0.4 electrolyte solution for fluid therapy in the patients undergoing meningioma resection. Methods Ninety-two American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m2, with expected operation duration>3 h, undergoing elective meningioma resection, were divided into 2 groups (n=46 each) using a random number table method: lactated Ringer′s solution (LR) group and HES group. LR was infused throughout operation in group LR, and 6% HES was intravenously infused in group HES, with the maximum dose not exceeding 50 ml/kg, and the excess part was supplemented with LR. Goal-directed fluid therapy was used to maintain stroke volume variation<13% and mean arterial pressure 70-90 mmHg. Arterial blood gas analysis was performed immediately before anesthesia induction (T0), when 1 000 and 2 000 ml of fluid were infused (T1, 2), and at the end of surgery (T3) to record electrolyte and acid-base balance indexes. Thromboelastogram was simultaneously monitored. The occurrence of electrolyte disorder, acid-base imbalance and abnormal coagulation function and consumption of norepinephrine were recorded. Patients were followed up at 3 and 7 days after surgery, and the Chinese quality of recovery-15 scores were recorded. The hospitalization time and occurrence of brain edema, pulmonary edema, nausea and vomiting were recorded. Results In group L and group H, 4 cases and 6 cases were excluded due to prolonged operation time, and 42 cases and 40 cases were finally included, respectively. Compared with LR group, the plasma Na+ concentration was significantly increased at T3, the plasma Cl- concentration and pH value were increased at T1-3, the plasma Ca2+ concentration was decreased at T2, 3, reaction time was increased at T3, coagulation time was increased and maximum amplitude was decreasedat T2, 3, and coagulation Angle was decreased at T1-3(P<0.05). No electrolyte disorder and abnormal coagulation function was found in the two groups. There was no statistically significant difference in the consumption of norepinephrine, postoperative Chinese quality of recovery-15 score, length of hospital stay and incidence of alkalosis, pulmonary edema, brain edema, and nausea and vomiting between the two groups (P>0.05). Conclusions The efficacy of liquid therapy is comparable between HES and LR in the patients undergoing meningioma resection.
Abstract
Objective To evaluate the efficacy of 6% hydroxyethyl starch (HES) 130/0.4 electrolyte solution for fluid therapy in the patients undergoing meningioma resection. Methods Ninety-two American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m2, with expected operation duration>3 h, undergoing elective meningioma resection, were divided into 2 groups (n=46 each) using a random number table method: lactated Ringer′s solution (LR) group and HES group. LR was infused throughout operation in group LR, and 6% HES was intravenously infused in group HES, with the maximum dose not exceeding 50 ml/kg, and the excess part was supplemented with LR. Goal-directed fluid therapy was used to maintain stroke volume variation<13% and mean arterial pressure 70-90 mmHg. Arterial blood gas analysis was performed immediately before anesthesia induction (T0), when 1 000 and 2 000 ml of fluid were infused (T1, 2), and at the end of surgery (T3) to record electrolyte and acid-base balance indexes. Thromboelastogram was simultaneously monitored. The occurrence of electrolyte disorder, acid-base imbalance and abnormal coagulation function and consumption of norepinephrine were recorded. Patients were followed up at 3 and 7 days after surgery, and the Chinese quality of recovery-15 scores were recorded. The hospitalization time and occurrence of brain edema, pulmonary edema, nausea and vomiting were recorded. Results In group L and group H, 4 cases and 6 cases were excluded due to prolonged operation time, and 42 cases and 40 cases were finally included, respectively. Compared with LR group, the plasma Na+ concentration was significantly increased at T3, the plasma Cl- concentration and pH value were increased at T1-3, the plasma Ca2+ concentration was decreased at T2, 3, reaction time was increased at T3, coagulation time was increased and maximum amplitude was decreasedat T2, 3, and coagulation Angle was decreased at T1-3(P<0.05). No electrolyte disorder and abnormal coagulation function was found in the two groups. There was no statistically significant difference in the consumption of norepinephrine, postoperative Chinese quality of recovery-15 score, length of hospital stay and incidence of alkalosis, pulmonary edema, brain edema, and nausea and vomiting between the two groups (P>0.05). Conclusions The efficacy of liquid therapy is comparable between HES and LR in the patients undergoing meningioma resection.
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