Motsch J, Geiger K
Institut für Anaesthesie, Universitätskliniken des Saarlandes, Homburg-Saar.
Reg Anaesth. 1991 Jan;14(1):9-16.
We investigated the effects of 6% hydroxyethyl starch (HES 40/0.5) and lactated Ringer solution (LRS) on blood coagulation tests and laboratory parameters during epidural anesthesia. Additionally, the efficacy of this prophylactic intravenous fluid supply in preventing sympathetic blockade induced hypotension was studied. METHODS. A single shot lumbar epidural block was given to 55 patients using 14-18 ml of bupivacaine 0.75%. The patients were randomized to receive either 1000 ml 6% HES 40/0.5 or 1000 ml LRS starting 5 min before the epidural blockade was set. The first 500 ml was infused during a 15-min period and the remaining 500 ml solution during the next 30 min. Cardiovascular parameters were recorded and blood samples were taken 30, 60, 120 and 240 min after the start of the infusion. RESULTS. No significant differences were found in the cardiovascular parameters, although in patients with a cranial spread of epidural blockade above T 10, patients who received LRS showed more episodes of severe hypotension. Serum osmolarity, potassium and sodium remained constant throughout the observation period. HES 40/0.5 caused a significantly greater hemodiluting effect than LRS, which was evident in more pronounced temporary decreases in serum protein concentration, hemoglobin concentration, hematocrit, fibrinogen and platelets. In coagulation parameters LRS caused no changes of PTT and Quick, whereas HES 40/0.5% led to a significant prolongation of PTT and a decrease in Quick. CONCLUSION. Fluid supply with either LRS or 6% HES 40/0.5 cannot prevent the epidural blockade induced hypotension entirely. In epidural anesthesia with spread of blockade above T 10, 6% HES 40/0.5 is superior to LRS in the prevention of severe hypotension. The temporary increase in plasma volume after infusion of 6% HES 40/0.5 results in a greater hemodilution with a concomitant decrease of blood viscosity and improved microcirculation flow. These might be of interest in prevention of thromboembolic complications. The specific effects of the two solutions were also determinable during epidural blockade.
我们研究了6%羟乙基淀粉（HES 40/0.5）和乳酸林格氏液（LRS）在硬膜外麻醉期间对凝血试验和实验室参数的影响。此外，还研究了这种预防性静脉补液在预防交感神经阻滞引起的低血压方面的效果。方法。对55例患者使用14 - 18 ml 0.75%布比卡因进行单次腰段硬膜外阻滞。患者被随机分为两组，在硬膜外阻滞开始前5分钟开始，分别接受1000 ml 6% HES 40/0.5或1000 ml LRS。前500 ml在15分钟内输注完毕，其余500 ml溶液在接下来的30分钟内输注。记录心血管参数，并在输注开始后30、60、120和240分钟采集血样。结果。心血管参数未发现显著差异，尽管在硬膜外阻滞范围高于T10且有颅神经扩散的患者中，接受LRS的患者出现严重低血压的次数更多。在整个观察期内，血清渗透压、钾和钠保持恒定。HES 40/0.5引起的血液稀释作用明显大于LRS，这在血清蛋白浓度、血红蛋白浓度、血细胞比容、纤维蛋白原和血小板更明显的暂时下降中表现出来。在凝血参数方面，LRS未引起PTT和Quick值的变化，而HES 40/0.5%导致PTT显著延长和Quick值下降。结论。LRS或6% HES 40/0.5补液均不能完全预防硬膜外阻滞引起的低血压。在硬膜外阻滞范围高于T10的硬膜外麻醉中，6% HES 40/0.5在预防严重低血压方面优于LRS。输注6% HES 40/0.5后血浆容量的暂时增加导致更大程度的血液稀释，同时血液粘度降低，微循环血流改善。这些可能对预防血栓栓塞并发症有意义。在硬膜外阻滞期间也可确定这两种溶液的具体作用。
