急性等容血液稀释对冠心病患者结肠代膀胱术中血流动力学、氧代谢和血液流变学的影响

Effects of Acute Normovolemic Hemodilution on Hemodynamics,Hemorheology,Oxygen Transport and Consumption During Ileat-Golon Bladder Replacement Operation on Coronary Heart Disease Patients

目的探讨急性等容血液稀释对冠心病患者结肠代膀胱术中血流动力学、氧代谢和血液流变学的影响。方法择期冠心病患者结肠代膀胱术38例，男28例，女10例，年龄41～63岁，体重47～75k，随机分成急性等容血液稀释组和对照组，每组19例。经右颈内静脉置入7FSwan—Ganz漂浮导管，桡动脉、股静脉置管。监测心电图及各项血流动力学指标，急性等容血液稀释组经桡动脉放血（8～12mL/kg），同时以相同速率经股静脉输入同量贺斯。在血液稀释前、血液稀释即刻、稀释后30min及60min抽取桡动脉、股静脉和肺动脉血各3mL以检测血液流变学指标，并进行血气分析。对照组则在对应时间点抽血检测血液流变学指标和血气分析。结果急性等容血液稀释组患者在血液稀释后心率、平均动脉压、平均肺动脉压、毛细血管楔压、中心静脉压均无明显变化．心输出量和心脏指数在血液稀释后上升明显，体循环指数和肺循环指数在稀释后下降，红细胞压积、全血粘度、红细胞聚集指数均在稀释后有所下降。结论对冠心病患者结肠代膀胱术前进行中度急性等容血液稀释其血流动力学稳定，可增加组织血流灌注，对氧供无影响，减少术中血液丢失，减少库血的使用，同时可能具有增加心脏灌注的作用。

Aim To study effects of acute normovolemic hemodilution （ANH） on hemodynamics, hemorheology, oxgen transport and consumption during lleat-Golon Bladder Replacement Operation on coronary heart disease patierts, Methods Thirty-eight ceronary heart disease patients （28 males, 10 females） aged 41 - 63 years weighing 47 - 75 kg undergoing elective lleat-Colon Bladder Replacement Operations were randomly divided into 2 groups with 19 patients in each group： ANH group and control group, Right internal jugular vein was earmulated with 7F Swan-Ganz floating earmula for central venous pressure （CVP） monitoring and blood sampling radial artery was eannulated blood pressure monitoring and blood gas analysis, femoral vein was earmulatel for blood sampling and fluid infusion. Blood （8- 12 mL/kg） was removed from radial artery in ANH group and normovolemie was maintained by simultaneous infusion of 6% HEAS, Electmeardiogram （ECG）, blood pressure （ BP）, central venous pressure were centinuously monitored throughout the operation. Arterial and central venous blood samples were taken for blood gas analysis before and after ANH. Results There were no significant changes in heart rate （HR）, mean arterial pressure （MAP）, mean ptdmonary artery pressure （MPAP）, pulmonary capillary wedge pressure （PCWP） and CVP after ANH. There were no significant difference in parameters of blood gas analysis between two groups, Conclusion ANH can be safely used for coronary heart disease during lleat-Golon Bladder Replacement Operations, and acute normovolemic hemodilution may have heart protection function.