贺斯在食道癌手术前高容量血液稀释中的应用

Study of Preoperative Acute Hypervolemic Hemodilutinn Infused with 6% Hydroxylstarch in Patients Undergoing Esophageal Carcinoma Radical Surgery

目的探讨术前高容量血液稀释(AHH)在全麻复合硬外麻醉下食道癌手术患者中应用的可行性.方法ASA I～Ⅱ级病人42例,随机分为观察组(H组)和对照组(C组),均在全麻复合连续硬膜外麻醉下施行.H组:于切皮前输入6%贺斯1000ml,按50ml/min输入.C组:输注复方氯化钠液,方法同H组.持续监测MAP、HR、SPO2和PsrCO2;分别于稀释前、稀释后、术毕、术后第1 d和第7 d测定红细胞压积(HCT)、凝血功能(PT、APTT、FIB)的变化;记录术中输血量和输液量;计算出血量.结果术中两组病人出血量和输液量无显著性差异(P＞0.05),输血量及输血病人数H组明显低于C组(P＜0.05).H组MAP的变化明显低于C组(P＜0.05),稀释后,HR明显降低(P＜0.05),中心静脉压(CVP)明显升高(P＜0.01),但尚在正常生理范围.H组的HCT在稀释后及术中明显低于基础值及C组(P＜0.05),但在术毕和术后第1 d及第7d两组间无显著性差异.PT、APTT及FIB于组间比较均无显著性差异(P＞0.05).结论全麻复合硬膜外麻醉下食道癌手术病人施行AHH可有效维持血流动力学平稳及提高对失血的耐受性.

Objective To investigate the feasibility of preoperative acute hypervolemic hemodilution (AHH) infused with 6% Hydroxyistarch in anesthesia combined general and epidural during esophageal carcinoma radical surgery.Methods Fouty-two ASAⅠ~Ⅱpatients were randomized into two groups:group H and group C, each consisting 21 cases.Group H were infused with 6% Hydroxyistarch (HES) 1000ml at a rate of 50ml/min before skin incision. Group C were replaced with Ringers,solution 1000ml MAP,HR,SpO 2 and P ET CO 2 were monitored during the operation.HCT,PT,APTT and FIB were measured before and after preoperative hemodilution, the end of operation, and 1 d,7 d after operation. The volume of normal saline infused, the volume of blood loss and bank-blood infused were recorded.Results There were no significant differences in PT,APTT,FIB before and after hyperhemodilution between the two groups.The volume of saline infusion and blood loss were similar,but the blood transfused cases and the volume of band blood reduced significantly in group H(P<0.05).Compared with those in group C,HR reduced significantly (P<0.05);the MAP less changed (P<0.05);HCT decreased markedly after hyperhemodilution and during surgery (P<0.05),but without significant differences in the first and seventh postoperative day (P>0.05).Conclusions Preoperative AHH is feasible to Stable hemodynamics and reinforce the tolerance to blood loss in patients undergone thoracotomy surgery.