羟乙基淀粉术前急性高容量血液稀释在肺癌手术中的应用

Preoperative acute hypervolemic hemodilution with hydroxyethyl starch in patients undergoing lung cancer resection

目的观察羟乙基淀粉（HES）术前急性高容量血液稀释（AHH）在全麻复合硬膜外阻滞下肺癌手术患者中应用的可行性。方法ASAⅠ～Ⅱ级患者42例，随机分为观察组（V组）和对照组（C组）。V组：于切皮前50ml／min输入6％HES130／0．41000ml。C组：输注等量复方氯化钠。持续监测MAP、HR、SpO2和PETCO2。分别于稀释前、稀释后、术毕、术后第1天和第7天测定红细胞压积（Hct）、凝血酶原时间（PT）、部分凝血活酶时间（APTT）和纤维蛋白原浓度（Fib）的变化；记录术中输血量和输液量；计算出血量。结果术中两组患者出血量和输液量差异无显著意义，输血量及输血患者人数V组明显低于C组（P〈0．05）。V组MAP的变化明显低于C组（P〈0．05），稀释后，HR明显减慢（P〈O．05），CVP明显升高（P〈0．01），但尚在正常生理范围。V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天及第7天两组间差异无显著意义。PT、APTT及Fib组间比较差异均无显著意义。结论全麻复合硬膜外阻滞下肺癌手术患者使用HES施行AHH可有效维持血液动力学平稳及提高患者对失血的耐受性。

Objective To investigate the feasibility of preoperative acute hypervolemic hemodilution （AHH） with voluven during lobectomy under general anesthesia combined with epidural block. Methods Forty-two ASA Ⅰ - Ⅱ patients with lung cancer were divided randomly into two groups with 21 cases each. Group V were infused with 6 % hydroxyethyl starch 130/0.4 （Voluven） 1 000 ml at a rate of 50 ml/min before skin incision. Group C were replaced with Ringers solution 1 000 ml. MAP, HR, SpO2 and PETCO2 were monitored during the operation. Hct, PT, APTT and Fib were measured before and after hemodilution, at the end of operation, on the 1 st, 7 st day after operation. The volumes of normal saline infused, blood loss and bank-blood infused during operation were recorded. Results There was no significant difference in PT, APTT, Fib before and after AHH between the two groups. The volumes of saline infusion and blood loss of two groups were similar, but the number of blood transfusion cases and the volume of band blood infused were less significantly ingroup V than those in group C （P〈0. 05）. With less changes in HR and MAP （P〈0.05）. Hct decreased and CVP increased markedly during surgery ingroup V （P〈0.05）, but there was no significant difference in Hct on the 1 st and 7 st postoperative clay between the two groups. Conclusion Preoperative AHH with Voluven is feasible to stabilize hemodynamics and reinforce the tolerance to blood loss in patients undergoing lung cancer resection.