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目的观察围生期不同液体治疗重度子前期并发腹腔积液的临床效果,寻找较好的液体管理方式。方法分析2010年1月~2012年12月南方医科大学附属深圳市妇幼保健院入院确诊的围生期重度子前期并发腹腔积液患者。治疗组55例,围生期使用6%羟乙基淀粉130/4.0注射液和呋塞米注射液静脉微泵滴注治疗;对照组52例,围生期使用5%人血清蛋白加呋塞米静脉微泵滴注治疗。观察两组患者生命体征、胶体渗透压、血液黏稠度等的变化情况,并对比两组肺水肿等并发症的发生率。结果治疗组剖宫产术后24 h血压显著低于对照组,而心率和血氧饱和度比较显著高于对照组(均P<0.05);对照组术后肺水肿发生率17.3%,而治疗组无一例出现肺水肿;治疗组术后第5天红细胞压积和24 h尿蛋白显著低于对照组,胶体渗透压显著高于对照组(均P<0.05);而术后第5天两组血浆清蛋白比较,差异无统计学意义(P>0.05);治疗组水肿完全消退的时间显著少于对照组[(2.43±0.37)d比(3.74±0.59)d,P<0.01]。结论重度子前期并发腹腔积液围生期患者使用6%羟乙基淀粉130/4.0注射液加呋塞米注射液静脉微泵滴注治疗可以有效提高胶体渗透压,并改善水肿、血容量不足和微循环粘滞状态,维持重要脏器的氧供,减少肺水肿等并发症的发生。
Objective To observe the clinical effect of different liquids in perinatal period for the treatment of severe preeclampsia with ascites and to find a better way of liquid management. Methods From January 2010 to December 2012, the patients with preeclampsia and peritoneal hydrops inpatients diagnosed as perinatal severe gynecology in Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University were enrolled. The treatment group, 55 cases of perinatal use of 6% hydroxyethyl starch 130 / 4.0 injection and furosemide intravenous infusion of micro-pump infusion; control group of 52 patients, perinatal use of 5% human serum protein plus furosemide Micropuncture intravenous infusion pump treatment. The changes of vital signs, colloid osmotic pressure and blood viscosity of the two groups were observed, and the incidence of complications such as pulmonary edema were compared between the two groups. Results The blood pressure at 24 h after cesarean section in the treatment group was significantly lower than that in the control group, while the heart rate and oxygen saturation were significantly higher than those in the control group (all P <0.05). The incidence of postoperative pulmonary edema in the control group was 17.3% No pulmonary edema was found in any group. The hematocrit and 24 h urinary protein in the treatment group were significantly lower than those in the control group on day 5 postoperatively, and the colloid osmotic pressure was significantly higher than that in the control group (all P <0.05) (P> 0.05). The eradication time of treatment group was significantly less than that of control group [(2.43 ± 0.37) d vs (3.74 ± 0.59) d, P <0.01]. Conclusion Intraperitoneal micro-pump infusion of 6% hydroxyethyl starch 130 / 4.0 injection plus furosemide injection in patients with severe preeclampsia perinatal period complicated with peritoneal effusion can effectively improve the colloid osmotic pressure and improve the edema and blood volume Insufficient and microcirculation of viscous state, to maintain oxygen supply of vital organs, reduce the occurrence of complications such as pulmonary edema.