术前急性高容量血液稀释对病人血气和电解质的影响

The effect of acute hypervolemic hemodilution on blood gas and electrolytes

目的比较乳酸钠林格液、万汶和佳乐施用于术前急性高容量血液稀释对病人血气和电解质的影响。方法30例择期脑膜瘤手术病人随机分为乳酸钠林格液组(Ⅰ组)、万汶组(Ⅱ组)和佳乐施组(Ⅲ组),每组10例。麻醉诱导前,分别用相应液体以20ml/(h.kg)的速度AHHD30min,诱导时及以后继续用相应液体20ml/(h.kg)的速度AHHD30min后手术。并于AH-HD前(T1)、AHHD毕(T2)、AHHD后60min(T3)、AHHD后120min(T4)采集动脉血待测血气指标及电解质。结果三组AHHD后,HCT在T2、T3、T4点均较T1点降低P<0.01,AHHD毕与AHHD前比较乳酸钠林格液组HCT降低8.9%,万汶组降低24.8%,佳乐施组降低17.1%。三组病人AHHD后与AHHD前比较,PH、K+无明显变化P>0.05,HCO3-PaCO2均降低P<0.01。AHHD毕与AHHD前比较,Na+、CL-均升高P<0.01,Ca2+的变化万汶组和佳乐施组均降低P<0.01。结论术前AHHD能维持血流动力学的稳定,用万汶和佳乐施扩容效果优于乳酸钠林格液,且万汶优于佳乐施;AHHD对血气指标无明显影响;三组AHHD后CL-均增加,而万汶组和佳乐施组AHHD后Ca2+降低,应予以注意,必要时及时补充钙离子。

Objective To compare the effect of acute hypervolemic hemodilution by Lactated Ringer＇s solution,Voluven and Gelofusine on blood gas and electrolytes. Methods Thirty patients undergoing scheduled elective meningioma operation were randomly divided into 3 groups; Group Ⅰ （AHHD with lactated Ringer＇s solution）, Group Ⅱ （AHHD with voluven）, Group Ⅲ（AHHD with gelofusine）, with 10 in each group. AHHD was performed by infusing 20ml/（h. kg） solution 30 minutes before induction and infusing 20ml/（h. kg）solution 30 minutes during and after induction, then the operation was began. Collected arterial blood samples before AHHD （T1）,at the end of AHHD（T2）, 60 minutes after AHHD （T3）, 120 minutes after AHHD（T4） respectively for determining blood gas and electrolytes. Results Within three groups, after AHHD the HCT decreased significantly at T2,T3,T4 compared with T1 P〈0.01. At the end of AHHD, HCT decreased by 8.9% in group Ⅰ, 24.8% in group Ⅱ, 17. 1% in group Ⅲ compared with T1. Changes on PH and K^＋ , Compared with T1, there were no significant differences at T2,T3,T4 P〉0.05. Compared with before AHHD, HCO3^- ,PaCO2 decreased significantly after AHHD P〈 0.01. Compared with before AHHD, Na^＋ ,CL^- increased significantly at the end of AHHD P〈0.01; Ca^2＋ decreased significantly at the end of AHHD in group Ⅱ and group Ⅲ P〈0.01. Conclusions AHHD before operation can maintain stable hemedynamics, Voluven and gelofusine are more reliable than lactated Ringer＇ s solution in its volume expansion effect and voluven is better than gelofusine ; AHHD has no significant effect on blood gas; After AHHD CL^- increased in three groups, and Ca^2＋ decreased in group Ⅱ and group Ⅲ . Attentions should be taken and supplement Ca^2＋ necessarily.