羟乙基淀粉氯化钠预扩容对糖尿病患者术中血液流变学的影响

发布时间：2018-06-03 22:57

本文选题：羟乙基淀粉 + 糖尿病　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:针对2型糖尿病患者存在的血液高黏度的病理改变,本课题选用羟乙基淀粉(130/0.4)氯化钠注射液(商品名:万汶)术前预扩容进行血液稀释,观察其对糖尿病患者血液流变学指标的影响,以探讨此方法应用于围术期糖尿病患者的临床意义。方法:根据课题的纳入、排除标准选取了进行择期手术的2型糖尿病患者40例,并随机分成两组:试验组和对照组,入手术室后给予面罩吸氧、开放静脉液路、咪达唑仑镇静、常规监测,试验组于麻醉开始前30分钟内给予羟乙基淀粉(130/0.4)氯化钠注射液8ml/kg扩容,而对照组于麻醉开始前30分钟内给予等量的乳酸钠林格液扩容。扩容期间密切关注血流动力学的波动以及输液相关并发症和过敏事件的发生,同时记录监测指标:分别于扩容前、扩容结束时、麻醉开始时、手术切皮时及扩容后(液体输注完毕)1h五个时间点记录患者的心率、血压;与扩容前、扩容结束时及扩容后1h三个时间点记录患者的血糖值;于扩容前、扩容后1h两个时间点抽取静脉血检测血液流变学指标包括全血粘度、血浆粘度、红细胞聚集指数、Hb、HCT以及抽取动脉血检测血乳酸值。结果:两组患者的一般资料包括性别、年龄、身高、体重、BMI、糖尿病病史等比较,差异无统计学意义;与扩容前相比,两组扩容结束时的心率无明显变化,麻醉开始时、手术切皮时、扩容后1h的心率均有减慢,两组扩容结束时血压明显升高,麻醉开始时、手术切皮时、扩容后1h血压降低;与对照组相比,试验组患者的血压在麻醉开始时、手术切皮时降低程度较小;与扩容前相比,两组患者的血糖值在扩容结束时无明显变化,而在扩容后1h均有明显升高,但与对照组相比,试验组各时间点血糖无明显升高,结果无统计学意义;与扩容前相比,对照组扩容后的血浆粘度、红细胞聚集指数降低不明显,差异无统计学意义(P0.05),而全血粘度、血红蛋白量、红细胞压积以及动脉血乳酸值有明显降低,差异有统计学意义(P0.05);试验组扩容后的全血粘度、血浆粘度、红细胞聚集指数、血红蛋白量、红细胞压积以及动脉血乳酸值均有明显降低,差异有统计学意义(P0.05)。与对照组相比,试验组扩容前的所有检测指标差异无统计学意义(P0.05);试验组扩容后的血浆粘度、红细胞聚集指数、红细胞压积以及动脉血乳酸值下降程度更大,差异有统计学意义(P0.05),其余指标的比较差异无统计学意义(P0.05)。结论:择期手术的2型糖尿病患者在术前应用乳酸钠林格液和羟乙基淀粉(130/0.4)氯化钠注射液扩容均能降低患者血液的全血粘度、血红蛋白量、红细胞压积以及动脉血乳酸值,但羟乙基淀粉(130/0.4)氯化钠注射液还能明显降低患者的血浆粘度和红细胞的聚集性,且更能稳定循环功能,对围术期糖尿病患者具有一定的临床保护作用。
[Abstract]:Objective: to study the pathological changes of high blood viscosity in patients with type 2 diabetes mellitus, we used hydroxyethyl starch 130 / 0.4) sodium chloride injection (commercial name: Wanwen) to dilute the blood before operation. To investigate the clinical significance of this method in perioperative diabetic patients, we observed its effect on the hemorheology index of diabetic patients. Methods: 40 patients with type 2 diabetes mellitus undergoing elective operation were selected according to the exclusion criteria and were randomly divided into two groups: the experimental group and the control group. After entering the operating room, they were given oxygen inhalation by mask, open vein fluid and midazolam sedation. Routine monitoring, the experimental group was given hydroxyethyl starch 130 / 0.4) sodium chloride injection 8ml/kg expansion within 30 minutes before anesthesia, while the control group was given the same amount of sodium lactate Ringer solution 30 minutes before anesthesia. During the dilatation period, the fluctuation of hemodynamics and the occurrence of transfusion related complications and allergic events were closely followed, and the monitoring indexes were recorded: before expansion, at the end of expansion, at the beginning of anesthesia, Heart rate and blood pressure were recorded at 5 time points after skin incision and dilatation (1 h after fluid infusion; blood glucose values were recorded at 3 time points before, at the end of dilatation and 1 hour after dilatation). Blood rheological parameters including whole blood viscosity, plasma viscosity, erythrocyte aggregation index (HCT) and blood lactic acid were measured at two time points after dilatation. Results: the general data of the two groups included sex, age, height, weight, diabetes history, etc. There was no significant difference between the two groups, and there was no significant change in heart rate at the end of the dilatation, and at the beginning of anesthesia, there was no significant difference between the two groups at the end of the dilatation. The heart rate decreased at 1 hour after scalding, and increased significantly at the end of dilatation in both groups. The blood pressure decreased at the beginning of anesthesia and 1 hour after scalping. Compared with the control group, the blood pressure of the patients in the test group was at the beginning of anesthesia. The blood glucose level of the two groups did not change significantly at the end of the expansion, but increased significantly at 1 hour after the expansion, but there was no significant increase in the blood glucose at each time point in the experimental group compared with the control group. Results there was no significant difference in plasma viscosity and erythrocyte aggregation index between the control group and the control group (P 0.05), but the whole blood viscosity and hemoglobin content were not significantly decreased in the control group. The whole blood viscosity, plasma viscosity, erythrocyte aggregation index, hemoglobin content were significantly decreased in the test group, and the difference was statistically significant (P 0.05). The hematocrit and arterial blood lactic acid decreased significantly (P 0.05). Compared with the control group, there was no significant difference in all the indexes before the expansion in the trial group (P 0.05), but the plasma viscosity, erythrocyte aggregation index, hematocrit and arterial blood lactic acid decreased significantly in the experimental group. The difference was statistically significant (P 0.05), but there was no significant difference in other indexes (P 0.05). Conclusion: preoperative dilatation of sodium lactate Ringer's solution and hydroxyethyl starch (130 / 0.4) sodium chloride injection can reduce the whole blood viscosity, hemoglobin content, hematocrit and arterial blood lactic acid value in patients with type 2 diabetes mellitus undergoing elective operation. However, hydroxyethyl starch (130 / 0.4) sodium chloride injection can significantly reduce plasma viscosity and erythrocyte aggregation, and more stable circulation function, and has a certain clinical protective effect on perioperative diabetic patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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