本文選題：羥乙基淀粉 + 糖尿病��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:針對(duì)2型糖尿病患者存在的血液高黏度的病理改變,本課題選用羥乙基淀粉(130/0.4)氯化鈉注射液(商品名:萬(wàn)汶)術(shù)前預(yù)擴(kuò)容進(jìn)行血液稀釋,觀察其對(duì)糖尿病患者血液流變學(xué)指標(biāo)的影響,以探討此方法應(yīng)用于圍術(shù)期糖尿病患者的臨床意義。方法:根據(jù)課題的納入、排除標(biāo)準(zhǔn)選取了進(jìn)行擇期手術(shù)的2型糖尿病患者40例,并隨機(jī)分成兩組:試驗(yàn)組和對(duì)照組,入手術(shù)室后給予面罩吸氧、開(kāi)放靜脈液路、咪達(dá)唑侖鎮(zhèn)靜、常規(guī)監(jiān)測(cè),試驗(yàn)組于麻醉開(kāi)始前30分鐘內(nèi)給予羥乙基淀粉(130/0.4)氯化鈉注射液8ml/kg擴(kuò)容,而對(duì)照組于麻醉開(kāi)始前30分鐘內(nèi)給予等量的乳酸鈉林格液擴(kuò)容。擴(kuò)容期間密切關(guān)注血流動(dòng)力學(xué)的波動(dòng)以及輸液相關(guān)并發(fā)癥和過(guò)敏事件的發(fā)生,同時(shí)記錄監(jiān)測(cè)指標(biāo):分別于擴(kuò)容前、擴(kuò)容結(jié)束時(shí)、麻醉開(kāi)始時(shí)、手術(shù)切皮時(shí)及擴(kuò)容后(液體輸注完畢)1h五個(gè)時(shí)間點(diǎn)記錄患者的心率、血壓;與擴(kuò)容前、擴(kuò)容結(jié)束時(shí)及擴(kuò)容后1h三個(gè)時(shí)間點(diǎn)記錄患者的血糖值;于擴(kuò)容前、擴(kuò)容后1h兩個(gè)時(shí)間點(diǎn)抽取靜脈血檢測(cè)血液流變學(xué)指標(biāo)包括全血粘度、血漿粘度、紅細(xì)胞聚集指數(shù)、Hb、HCT以及抽取動(dòng)脈血檢測(cè)血乳酸值。結(jié)果:兩組患者的一般資料包括性別、年齡、身高、體重、BMI、糖尿病病史等比較,差異無(wú)統(tǒng)計(jì)學(xué)意義;與擴(kuò)容前相比,兩組擴(kuò)容結(jié)束時(shí)的心率無(wú)明顯變化,麻醉開(kāi)始時(shí)、手術(shù)切皮時(shí)、擴(kuò)容后1h的心率均有減慢,兩組擴(kuò)容結(jié)束時(shí)血壓明顯升高,麻醉開(kāi)始時(shí)、手術(shù)切皮時(shí)、擴(kuò)容后1h血壓降低;與對(duì)照組相比,試驗(yàn)組患者的血壓在麻醉開(kāi)始時(shí)、手術(shù)切皮時(shí)降低程度較小;與擴(kuò)容前相比,兩組患者的血糖值在擴(kuò)容結(jié)束時(shí)無(wú)明顯變化,而在擴(kuò)容后1h均有明顯升高,但與對(duì)照組相比,試驗(yàn)組各時(shí)間點(diǎn)血糖無(wú)明顯升高,結(jié)果無(wú)統(tǒng)計(jì)學(xué)意義;與擴(kuò)容前相比,對(duì)照組擴(kuò)容后的血漿粘度、紅細(xì)胞聚集指數(shù)降低不明顯,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而全血粘度、血紅蛋白量、紅細(xì)胞壓積以及動(dòng)脈血乳酸值有明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);試驗(yàn)組擴(kuò)容后的全血粘度、血漿粘度、紅細(xì)胞聚集指數(shù)、血紅蛋白量、紅細(xì)胞壓積以及動(dòng)脈血乳酸值均有明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。與對(duì)照組相比,試驗(yàn)組擴(kuò)容前的所有檢測(cè)指標(biāo)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);試驗(yàn)組擴(kuò)容后的血漿粘度、紅細(xì)胞聚集指數(shù)、紅細(xì)胞壓積以及動(dòng)脈血乳酸值下降程度更大,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余指標(biāo)的比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:擇期手術(shù)的2型糖尿病患者在術(shù)前應(yīng)用乳酸鈉林格液和羥乙基淀粉(130/0.4)氯化鈉注射液擴(kuò)容均能降低患者血液的全血粘度、血紅蛋白量、紅細(xì)胞壓積以及動(dòng)脈血乳酸值,但羥乙基淀粉(130/0.4)氯化鈉注射液還能明顯降低患者的血漿粘度和紅細(xì)胞的聚集性,且更能穩(wěn)定循環(huán)功能,對(duì)圍術(shù)期糖尿病患者具有一定的臨床保護(hù)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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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