急性超容血液稀释对电解质影响的研究

The effect of acute hypervolemic hemodilution on electrolytes

目的：探讨急性超容血液稀释（AHHD）对电解质的影响。方法：选择32例ASAⅠ～Ⅱ级全麻下择期行耳鼻喉科手术的患者，随机分为稀释组（n=16）和对照组（n=16）。全麻后施行急性超容血液稀释，使红细胞压积（Hct）下降至26．7％，以达到中等程度血液稀释状态。于AHHD前、AHHD后、手术结束时测定红细胞压积（Hct）、血红蛋白（Hb）、肝肾功能、凝血功能及电解质。结果：AHHD后Hct及Hb较AHHD前显著降低，Hct由（39．6±5．1）％下降至（26．7±3．2）％，Hb由（138．4±19．5）g／L下降至（90．7±10．8）g／L，分别下降了32．6％和34．5％。AHHD后血K^＋由AHHD前（3．9±0．3）mmol／L下降至（3．6±0．3）mmol／L，下降了7．7％；AHHD后血Ca^2＋（2．3±0．1）mmol／L较AHHD前（1．2±0．0）mmol／L明显降低，下降了47．8％。结论：急性超容血液稀释后钾离子及钙离子浓度明显降低，影响麻醉中使用的肌肉松弛剂的药效动力学，使肌肉松弛剂起效时间缩短，肌松作用增强。

Objective： To investigate the effect of AHHD on electrolytes. Methods： Thirty two patiefits, ASA Ⅰ～Ⅱ, scheduled for otolaryngologic surgery, were divided into two groups randomly （AHHD group and control group）. AHHD was performed after general anesthesia. Hct was decreased to 26.7%. Arterial blood samples were taken for determination of Hct, Hb, liver function, kidney function, electrolytes before and after AHHD, and at the end of the surgery. Results： Hct and Hb were significantly decreased after AHHD. Hct decreased from （39.6±5.1）% （before AHHD） to（26.7±3.2）% （after AHHD）. Hbdecreased from （138.4±19.5）g/L （before AHHD） to （90.7±10.8）g/L （after AHHD）.Hct and Hb descended by 32.6% and 34.5%, respectively. K^＋ decreased from （3.9±0.3）mmol/L （before AHHD） to （3.6±0.3）mmol/L （after AHHD）. Ca^2＋ decreased from （2.3±0.1）mmol/L （before AHHD） to （1.2＋0.0）mmol/L （after AHHD）. K^＋ and Ca^2＋ after AHHD were significantly lower than those before AHHD, descended by 7.7% and 47.8%, respectively. Conclusion： Concentrations of K^＋ and Ca^2＋ decrease significantly after AHHD. This will influence pharmacodynamics of muscle relaxants used in anesthesia, decrease the onset time, increase the potency.