Yatabe Tomoaki, Nishigaki Atsushi, Tamura Takahiko, Yokoyama Masataka
Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
J Anesth. 2017 Apr;31(2):291-293. doi: 10.1007/s00540-016-2301-3. Epub 2016 Dec 24.
Hydroxyethyl starch (HES) is widely used to prevent and treat spinal anesthesia-induced hypotension during cesarean section. However, the use of saline-based HES may lead to hyperchloremia. This study aimed to clarify the effects of saline-based HES on umbilical cord chloride level at delivery. We retrospectively analyzed 93 consecutive single-pregnancy patients who underwent cesarean section with combined spinal-epidural anesthesia. The patients were divided into two groups, depending on the use of 6% HES 130/0.4: group A (461 ± 167 ml of saline-based HES was administered; 43 patients) and group B (HES not administered; 50 patients). The major outcome was umbilical cord chloride level at delivery. The volume infused from operating room admission until delivery was not significantly different between groups. The umbilical cord chloride level at delivery was statistically significantly higher in group A than in group B, but clinically similar (108 ± 2 vs. 107 ± 2 mmol/l, P = 0.02). No differences were observed in the Apgar score or other umbilical cord laboratory data at delivery (Na, K, pH, base excess). In conclusion, we suggest that although the use of up to 500 ml of saline-based HES during cesarean section influences umbilical cord blood electrolytes, the effect is not of a clinically significant magnitude.
羟乙基淀粉（HES）被广泛用于预防和治疗剖宫产术中脊髓麻醉引起的低血压。然而，使用基于生理盐水的HES可能会导致高氯血症。本研究旨在阐明基于生理盐水的HES对分娩时脐带血氯水平的影响。我们回顾性分析了93例连续接受腰麻-硬膜外联合麻醉剖宫产的单胎妊娠患者。根据是否使用6% HES 130/0.4将患者分为两组：A组（给予461±167 ml基于生理盐水的HES；43例患者）和B组（未给予HES；50例患者）。主要结局指标是分娩时脐带血氯水平。两组从进入手术室到分娩期间的输液量无显著差异。A组分娩时脐带血氯水平在统计学上显著高于B组，但临床差异不大（108±2 vs. 107±2 mmol/L，P = 0.02）。分娩时的阿氏评分或其他脐带血实验室数据（钠、钾、pH值、碱剩余）无差异。总之，我们认为，尽管剖宫产术中使用多达500 ml基于生理盐水的HES会影响脐带血电解质，但这种影响在临床上并不显著。
