急性高容性血液稀释对老年人凝血及心脏功能的影响

Effects of acute hypervolemic hemodilution on coagulation and cardiac function in elderly patients with surgical diseases

目的研究急性高容性血液稀释对老年人凝血功能及心功能的影响.方法选择年龄60～70岁老年手术患者60例,ASA Ⅰ～Ⅱ级,随机分为三组,每组20例.麻醉后应用吸入异氟醚(Ⅰ组)、静脉泵入硝酸甘油(Ⅱ组)或佩尔地平(Ⅲ组)三种方法扩张血管的同时,以20ml/min速度静脉输注6%羟乙基淀粉(HES),观察血液稀释期间患者心功能和凝血功能的变化.结果静脉输注6% HES 500ml,各项心功能监测指标和凝血指标均无明显变化,组间比较无显著性差异;输注量达1000ml 时,Ⅱ组和Ⅲ组心功能各指标较基础值上升明显(P<0.05),三组各项凝血指标均较基础值呈下降趋势,但组间比较无显著性差异.结论在适当扩张血管的情况下,一定范围内的静脉滴注6% HES 1 000ml以内对老年手术患者(ASA Ⅰ～Ⅱ级)施行AHH是安全可行的,对机体凝血功能无明显影响.

Objective To study the effects of acute hypervolemic hemodilution （AHH） on the coagulation and cardiac function in elderly surgical patients. Method Sixty surgical patients, aged 60 to70, ASAⅠ～Ⅱ, were randomly divided into three groups （n=20 for each group）. 6% HES 500～1000ml was infused in a rate of 20ml/min during vasodilation with isoflurane inhalation （group 1）, nitroglycerin （group 2）, or nicardipine （group3） with the aid of an intravenous injection pump. The blood coagulation and cardiac functions were observed during hemodilution. Results No significant difference was found among the three groups on cardiac function and coagulation function during 500ml 6% HES infusion. When the volume of infusion was over 1000ml, the parameters of cardiac function increased and those of coagulation decreased significantly （P〈0.05） compared with the baseline in groups 2 and groups 3. Conclusion AHH with 6% HES less than 1000ml is safe within certain range vasodilation by using above three drugs, and no marked influence is found on blood coagulation in elderly patients （ASA Ⅰ～Ⅱ） undergoing surgery.