心脏瓣膜置换术期间血液稀释及其对血流动力学的影响

Hemodilution and its Effects on Hemodynamics during Operation for Cardiac Valve Replacement

采用Ｓｗａｎ－Ｇａｎｚ导管监测及动脉血血球压积（Ｈｃｔ）检测方法对２４例心脏瓣膜疾病病人在施行瓣膜置换术期间的血液稀释（ＨＤ）情况及其对血流动力学的影响进行了研究。结果显示，ＣＰＢ开始前由于失血和输入晶体液，Ｈｃｔ有所降低。并因血容量不足ＣＩ下降。ＣＰＢ期间Ｈｃｔ降至２５％左右，ＭＡＰ和ＳＶＲＩ也明显下降，３０ｍｉｎ后逐渐回升。ＣＰＢ结束后ＣＩ明显增高，Ｈｃｔ呈逐渐回增，术毕时达到麻醉前值的７８．６％。ＳＶＲＩ和ＭＡＰ于停机早期较低，后逐渐增高至接近正常值。ＣＰＢ前Ｈｃｔ与ＭＡＰ、ＭＰＡＰ、ＰＣＷＰ、ＰＶＲＩ、ＳＶＲＩ正相关，与ＣＩ负相关。ＣＰＢ中Ｈｃｔ与ＭＡＰ正相关。ＣＰＢ后Ｈｃｔ与ＭＡＰ、ＰＶＲＩ、ＳＶＲＩ、ＲＶＷＩ及ＬＶＷＩ正相关，与ＲＡＰ负相关。结果表明，心瓣置换木期间ＨＤ可通过多种机制影响血流动力学，尤对ＭＡＰ、ＳＶＲＩ及左、右心作功有重要影响。调整恰当的Ｈｃｔ是稳定循环的重要措施．

Hemodilution(HD)and its effects on hemodynamics were studied in 24 patients with valvular heart disease bymeans of Swan-Ganz catheter monitoring technique and artery hematocrit(Hct)detection during operation for car-diac valve replacement.The resluts showed Hct decreased slightly due to blood loss and crystalloid solution infu-sion,and CI was reduced as a reslut of hypovolumia before CPB。Hct decreased to approximately 25%due to fur-ther HD,MAP and SVRI also decreased significantly during CPB and progressively increased 30 minutes later.Hctincreased gradually post-CPB and reached to 78.6%of the pre-anesthetic value by the end of operation。 At he earlyperiod of termination of CPB。CI increased significangly but lowered MAP and SVRI returned to normal valuesgradually.The values of Hct and MAP MPAP,PVRI SVRI were positive correlated,while Hct and CI were in nega-tive relation during pre-CPB;Hct was positively related to MAP during CPB and to MAP,PVRI.SVRI.RVWI。LVWI after CPB but negatively related with RAP。The results suggest that HD influence hemodynamics by meansof multi-mechanisms during cardiac valve replacement。Hct has important effects on MAP。SVRI and work of theleft and right hearts.To adiust the Hct to a proper level is an important measure for the stability of circulation。