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目的探讨7·5%高渗盐水(HS)和6%羟乙基淀粉(HES)对择期腹部大手术后液体平衡和临床结果的影响。方法2003年6月至2005年12月江汉大学附属医院共对120例胃肠道肿瘤病人行根治性切除术。所有病人术毕进入外科ICU后分为3组,HS/HES组(n=40)输注7·5%高渗盐水(4mL/kg)后续6%羟乙基淀粉500mL,再续平衡液;HS组(n=40)输注7·5%高渗盐水(4mL/kg)后续平衡液;RL(单用平衡液)组(n=40)仅输平衡液。比较3组病人的输液量、尿量、液体平衡、体重变化、动脉血氧分压/吸氧浓度分数(PaO2/FiO2),以及并发症发生率和病死率。结果HS/HES组、HS组与RL组相比,HS/HES组、HS组手术日尿量较多,输液量减少;术后48h的液体正平衡量减少;术后体重增加值降低,PaO2/FiO2比值较高,总体并发症发生率和肺部感染发生率较低。HS/HES组与HS组相比,HS/HES组液体正平衡量减少及术后体重增加值降低更显著。结论7·5%高渗盐水有明显的利尿作用,可减少腹部大手术后的输液量和液体正平衡量,促进液体负平衡提前出现;并使术后总体并发症发生率和肺部感染发生率降低。联合应用6%羟乙基淀粉后效果更显著。
Objective To investigate the effect of 7.5% hypertonic saline (HS) and 6% hydroxyethyl starch (HES) on the fluid balance and clinical outcome after major abdominal operation. Methods From June 2003 to December 2005, a total of 120 gastrointestinal cancer patients underwent radical resection in Jianghan University Affiliated Hospital. All patients were divided into 3 groups after operation into the surgical ICU. The HS / HES group (n = 40) was infused with 500 mL hypertonic saline (4mL / kg) followed by 6% HS (n = 40) was infused with 7.5% hypertonic saline (4mL / kg) balance fluid and RL (n = 40) fluid only with balanced fluid. Infusion volume, urine output, fluid balance, body weight changes, PaO2 / FiO2, and incidence of complications and mortality were compared between the three groups. Results Compared with RL group, HS / HES group and HS group had more urine volume and less transfusion volume on the day of surgery than those in the RL group. The volume of fluid increased at 48h after surgery decreased, the PaO2 / FiO2 ratio is higher, the overall incidence of complications and lower incidence of pulmonary infection. HS / HES group compared with the HS group, HS / HES group decreased fluid balance and postoperative weight gain more significant reduction. Conclusion 7.5% hypertonic saline has significant diuretic effect, which can reduce the amount of transfusion and fluid balance after major abdominal surgery and promote the liquid negative balance to appear ahead of time. The overall incidence of postoperative complications and the incidence of pulmonary infection reduce. Combination of 6% hydroxyethyl starch after the effect is more pronounced.