急性等容血液稀释在冠心病患者非心脏手术中可行性分析

Effects of Acute Normovolemic Hemodilution on Hemodynamics,Hemorheology and Blood Gas Analysis during Operation on Coronary Heart Disease Patients

目的探讨急性等容血液稀释在冠心病患者非心脏手术中的可行性。方法择期冠心病非心脏手术患者28例,男18例,女10例,年龄44～61岁,体重54～79公斤。随机分成对照组和急性等容血液稀释组(简称稀释组)2组,每组14例。所有病例都经桡动脉,颈内静脉置管,监测心电图及各项血流动力学指标。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、60min抽取桡动脉血进行血气分析、抽取股静脉血以检测血液流变学指标。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。结果稀释组患者在血液稀释后心率、平均动脉压、和中心静脉压均无明显变化;红细胞压积和全血粘度有所下降(P<0.05);血气指标在血液稀释前后无明显变化;术中异体输血的例数明显低于对照组(P<0.05)。结论对冠心病患者术前进行中度急性等容血液稀释后能稳定血流动力学;保障组织供氧和耗氧的平衡;减少异体血的输注;有利于患者术后的康复。

Aim To study effects of acute normovolemic hemodilution on hemodynamics, hemorheology, during-Operation on coronary heart disease patierts, Methods Twenty-eight Corenary beart disease patients of sexes （ 18 male, 10 female） aged 44-61 yr weighing 54-79 kg undergoing elective operations were randomly divided into 2 groups with 14 patients in each group： Acute normovolemic hemodilution （ANH） group and control group, Right internal jugular vein was cannulated for CVP monitoring and blood sampling, Radial artery was cannulatcd for blood pressure monitoring and blood gas analysis, Femoral vein was cannulatel for blood sampling and fluid infusion. Blood （ 8-12 ml/kg） was removed from radial artery in ANH group and normovolemic was maintained by simultaneous infusion of 6% HEAS. ECG, BP, CVP were continuously monitored throughout the operation. Arterial and central venous Hood samples were taken for blood gas analysis before and after ANH. Results There were no significant changes in HR,MAP and GVP after ANH.And there were no significant difference in parameters of blood gas analysis between two groups,But the control group needing blood infusion from another was much more than ANH group. Conclusion ANH can be safely used for coronary heart disease during operations,efficiently prevent losing of blood and may have heart protection function.