用户注册|RSS订阅
位置: 主页 > 代写硕士论文 > 贺斯对血流动力学及凝血功能的影响

贺斯对血流动力学及凝血功能的影响

时间:2017-09-15 22:00:11 来源: 代写硕士论文

                      作者:王古岩,战淑桂,于力,林雪 ,陈雷

【关键词】  冠状动脉旁路移植术

    摘要:目的 探讨贺斯(HES)在体外循环(CPB)手术中对血流动力学及凝血功能的影响,明确HES在心血管手术中的应用价值。方法 选择40例行冠状动脉旁路移植术(CABG)的患者,随机分为HES组和佳乐施(GEL)组。HES组:在CPB前、CPB中用HES液静脉滴注和预充;GEL组:作对照,在CPB前、CPB中用GEL液静脉滴注和预充。观察给药前,给药后10min,停机后1h、4h和24h的血流动力学、氧供、氧耗和凝血功能指标。结果 两组患者各血流动力学、氧供和氧耗指标、凝血功能指标比较差别均无显著性意义(P>0.05)。结论 HES适用于CPB手术,对血流动力学和凝血功能均无明显影响。

  关键词:贺斯;佳乐施;体外循环;冠状动脉旁路移植术

  The Effect of Hydroxyethyl Starch on Hemodynamics and Coagulation In the Operation with Cardiopulmonary Bypass

  Abstract: OBJECTIVE To observe the effect of 6% hydroxyethyl starch (HES) for priming and volume replacement on hemodynamics and coagulation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), and to arsert the utility of HES in cardiovascular surgery. METHODS Forty patients undergoing coronary artery bypass graft (CABG)  were divided randomly into two groups: Group HES, using HES for priming and volume replacement before and during CPB; Group GEL, using GEL for priming and volume replacement before and during CPB.  The hemodynamic data, oxygen delivery (DO2), oxygen consumption (VO2), and coagulation function were measured in the two groups before priming the fluid, 10 minutes after priming the fluid, 1hour, 4hours, and 24 hours after CPB, respectively.  RESULTS There is no significant difference between these two groups in terms of hemodynamic data, DO2, VO2, and coagulation function (P>0.05).CONCLUSION  HES, without significant effect on hemodynamics and coagulation function, can be used in cardiac surgery with CPB.

  Key words:Hydroxyethyl Starch ; Gelofusine ; cardiopulmonary bypass ; coronary artery bypass graft

  贺斯(hydroxyethyl starch,HES )为第三代人造胶体,由玉米淀粉提炼而成,中分子量,低取代级,血管内存留时间较短,目前已广泛用于临床,但国内用于心血管手术的报道较少。我们以佳乐施(gelofusine,GEL)为对照,观察HES用于体外循环(CPB)下冠状动脉旁路移植术(CABG)患者的血流动力学和凝血功能变化,探讨其在心血管手术中的应用价值。

  1 资料与方法 

  1.1 临床资料                     

  本组40例患者均诊断为冠状动脉粥样硬化性心脏病,心功能Ⅱ~Ⅲ级,择期行CABG手术。将40例患者随机分为两组,每组20例,HES组:在CPB前、CPB中静脉滴注和预充HES液;GEL组:在CPB前、CPB中静脉滴注和预充GEL液。两组患者的性别、年龄、体重、心功能的差别均无显著性意义,见表1。两组均未合并其它心脏病,既往均无心血管手术史,肝肾功能、凝血系统功能正常,手术前7天停用阿司匹林类药物。表1 两组患者一般临床资料 (略)

  1.2  方法                       

  用咪唑安定0.2~0.3mg/kg, 阿端0.1mg/kg,芬太尼15ug/kg麻醉诱导;阿端0.15mg/kg,芬太尼35μg/kg,氨氟醚0.5%~1.0%麻醉维持;CPB前给予肝素 400u/ kg。常规监测心电图(ECG),桡动脉血压(BP),放置飘浮导管,监测血流动力学指标。HES组:30分钟内静脉滴注HES 500ml,CPB机内预充HES液1000ml;GEL组:30分钟内静脉滴注GEL 500ml,CPB机内预充GEL液1000ml。手术中如需额外输液,CPB前用乳酸林格氏液,CPB后输入机血,可酌情给予库存血。HES或 GEL静脉滴注完毕10min后,给予抑肽酶300万KIU;用抑肽酶200万KIU预充CPB机。停机后鱼精蛋白拮抗首剂为1∶1.3,总量给至1∶1.5。

代写硕士论文
代写毕业论文
代写职称论文
Copyright @copy 2008-2015 代写毕业论文 代写硕士论文 版权所有

需要代写的客户请联系:QQ:4000290153 电话:18952021229