琥珀酰明胶AHHD对胃肠道择期手术患者血流动力学、电解质和血气指标的影响

Effect of AHHD on hemodynamics,electrolytes andarterial blood gas in patients receiving scheduledgastrointestinal surgery

目的探讨琥珀酰明胶急性高容量血液稀释(AHHD)对胃肠道择期手术患者血流动力学、电解质和血气指标的影响。方法对15例胃肠道择期手术患者常规术前准备后入室全麻诱导,以30m l/(kg.h)速度经中心静脉输注4%琥珀酰明胶注射液行AHHD,总量为20m l/kg;外周静脉输注乳酸钠林格氏液补充正常丢失的体液。观察AHHD前后无创血压(N IBP)、心率(HR)、中心静脉压(CVP)、血气分析指标、血红蛋白(Hb)、红细胞压积(HCT)及电解质指标;计算琥珀酰明胶的扩容系数(EF)。结果AHHD期间平均输入琥珀酰明胶(1111±220)m l,乳酸钠林格氏液(456±88)m l;HCT从40.6%±4.3%降至36.0%±4.0%,达到轻度血液稀释水平,琥珀酰明胶EF为0.7±0.2。AHHD前后N IBP、HR、血钠、血钙无显著改变,但CVP升高、血钾下降均有显著差异(P<0.05);血气分析显示AHHD前存在轻微呼吸性碱中毒,AHHD后BE值降低(P<0.05)。结论以4%琥珀酰明胶行AHHD对N IBP、HR无明显影响,但20m l/kg时可致CVP明显升高;AHHD对血气指标无明显影响。

Objects： To study the effects of acute hypervolemic hemodilution （AHHD） on hemodynamics, electrolytes and arterial blood gas in patients undergoing scheduled gastrointestinal surgery. Methods： 15 patients routinely prepared for receiving scheduled gastrointestinal surgery were infused Gelofusine 20ml/kg with a rate of 30ml/（kg·h） for AHHD through central venous catheter after inducement of general anesthesia, and were infused Lactated Ringer＇s solution for complementing physiological fluid lost through peripheral venotls needle. The level of non-invasive blood pressure （NIBP）, central venous pressure （CVP）, electrocardiogram （ECG）, heart rate （HR）, hemoglobin （Hb）, hematocrit （HCT）, arterial blood gas and electrolytes were recorded and analyzed before and after AHHD. The expansion factor （EF） of Gelofusine was also calculated. Results： There was no significant difference in NIBP, HR, Hb and HCT before AHHD, but the level of serum natrium, potassium and calcium decreased markedly before AHHD （P〈0. 05）. The incidence of hypokalemia （73%） and hypocalcemia （73%） was significant （P〈0.05）. The average volume of Gelofusine for AHHD was （1111±220）ml, and the average volume of lactated Ringer＇s solution for physiological lost was （456±88）ml. HCT decreased from 40. 6%±4. 3% to 36.0%±4. 0% and got a mild AHHD level. The calculated EF of Gelofusine was 0. 7±0. 2. There was no significant change in NIBP, HR, serum natrium and potassium after AHHD, but CVP increased and serum potassium decreased markedly （P〈0. 05）. Blood gas analysis showed a mild respiratory alkalosis before AHHD, and nearly compensated after AHHD. Conclusions： CVP increases significantly but not NIBP and HR during AHHD with gelofusin 20ml/kg. AHHD would not cause significant change of blood gas.