The Comparison Of Two 6% Hydroxyethyl Starchs During Cardiac Value Replacement

Objective: Use 6%hydroxyethyl starch(HES) 130/0.4 in saline solution as positive contr-ol.To observe the efficacy and the effect of congulation ?electrolyte?acid-base balance between 6%hydroxyethyl starch(HES)130/0.4 in saline solution and 6%hydroxyethyl starc-h(HES)130/0.4 in a balanced electrolyte solution undergoing cardiac value replacement.Methods:We randomly assigned 80 patients undergoing elective cardiac value surgery who >18y?ASA?~??NYHA?~??CPB<3h and the local altitude less than 2500 m to receive either 6%HES130/0.4 in saline solution or 6%HES130/0.4 in a balanced electrolyte solution as the main infusion fluid perioperatively,0.9% salline were used for physicai requ-irement. Eligible patients were randomized into two groups comprising 40 patients.Mainta-in hemodynamic stability,record the amount of study fluid from the beginning to 6h after operation,Therapeutic equivalence regarding the primary variable was defined as the trea-ment difference 500 m L in the amount of the study drugs. The primary outcome variables were the congulation(PT?APTT?FIB?TT) of after introduction,postoperation 6h?24 h after surgery and chest tube drainage over the first 6h, 24 h after CPB as safety variables; arterial blood gas ?ion and acid-base balance also were recorded.Results:Two colloids have the equavalence on the effect of expand volumn,they all coul-d maintain hemodynamic stability,The mean dose was 1052±326 ml and 1263±449ml in 6%HES130/0.4130/0.4 in a balanced electrolyte solution? 6%HES130/0.4 in saline solu-tion group, respectively. The 95% confidence interval found for the difference between two treatments was(-24, 343 ml, mean,160ml),it was entirely contained in the predefined interval(-500, 500 m L).therefore, equivalence has been proven statistically.Besides,they have the similar change in congulation(PT?APTT?FIB?TT),did not show significant differences(P>0.05). Compared with 6%HES130/0.4 in saline solution, serum K+?p H was higher during CPB 5min ?5min after CPB and at the end of surgery in 6% HES130/0.4 in balanced solution,the supplement about 10%KCL was less,showed siginificant difference,at the same time CL- was lower in 6% HES130/0.4 in balanced solution(P<0.05).K+?p H?CL- all had no siginificant difference at the time of baseline?postoperation 6h?24h after operation(P>0.05).Conclusion:1.Under the condition of this study,6%HES130/0.4 in a balanced electrolyte solution and 6%HES130/0.4 in saline solution have the equavalence on the effect of expand volumn, they all could maintain Hemodynamic stability,have no obvious effects in congulation. 2.6%HES130/0.4 in a balanced electrolyte solution is better in maintain the plasma electr-olyte and acid-base balance.and avoid the hyperchloremic acidosis risk.Besides,10%KCL was need less to supplement,so that 6%HES130/0.4 in a balanced electrolyte solution was more convenient during anesthetic management.