6%羟乙基淀粉溶液与林格氏液行急性等容性血液稀释对血液成分的影响

The effect of acute normovolemic hemodilution by 6% HES and Ringer′s solution on blood composition

目的:探讨6%羟乙基淀粉溶液及林格氏液行急性等容血液稀释(ANHD)对机体血液成分的影响.方法:选择12例20～60岁、ASAⅠ～Ⅱ级全麻下择期行非心脏手术的病人.全麻后通过放出一定量自体血并同时输入1∶1等量的6%羟乙基淀粉溶液及0.5∶1的林格氏液,使HCT下降至26%,以达到中等程度血液稀释状态.在手术结束前或术中明显出血时回输放出的自体血.于ANHD前、ANHD后、手术结束时测定HCT、Hb及血电解质酸碱平衡指标.结果:ANHD后、手术结束时HCT及Hb较ANHD前显著降低,ANHD后HCT、Hb分别下降了34.38%和35.10%.ANHD后血K +下降了13.65%,血Ca2+也明显下降了39.80%.ANHD前、后其余指标变化差异均无统计学意义.结论:6%羟乙基淀粉溶液及林格氏液行ANHD时能有效地使HCT及Hb下降至靶水平,同时维持了机体血电解质及酸碱平衡,是一种安全有效的ANHD方法.

Objective： To investigate the effect of ANHD with 6% HES and Ringer＇s solution on blood composition. Methods： Twelve ASA Ⅰ～Ⅱ, 20～60 years old patients were selected and scheduled for noncardiac surgery under general anesthesia. After induction of anesthesia HCT was decreased to 26% by removing blood from the body of the patients and simultaneously infusing an equal volume （1 ： 1） of 6% HES and half volume （0.5 ： 1） of Ringer＇s solution to maintain intravascular volume. If significant surgical blood loss occurred or it was near the end of the operation, the transfusion of blood obtained by hemodilution could begin. Arterial blood samples were taken for determination of HCT, Hb, K^＋, Na^＋, Ca^2＋, and pH hefore and after ANHD, and at the end of the surgery. Results： HCT and Hb significantly decreased after ANHD. HCT and Hb descended by 34.38% and 35.10%, respectively. K^＋ and Ca^2＋ after ANHD were significantly lower than those before ANHD. Conclusion： ANHD with 6% HES and Ringer＇s solution can make HCT and Hb decrease to target level effectively, while maintaining the blood electrolyte and acid-base balance. It is a safety and effect method for hemodilution.