术前应用6%羟乙基淀粉行急性高容量血液稀释对老年患者动脉压及氧代谢的影响

Effect of acute hypervolemic hemodilution by using 6% hydroxyethyl starch on arterial pressure and oxygen metabolism in aged patients

目的:探讨应用6%羟乙基淀粉行急性高容量血液稀释(AHH)对老年患者动脉压和氧代谢的影响。方法:随机选择腹部择期手术的老年患者40例,随机分为两组,A组为高容量血液稀释组,B组为非血液稀释组。B组入室后补充基础生理需要量及禁食丧失需要量。A组患者以25m l/m in的速率输入6%羟乙基淀粉7m l/kg后诱导,同时继续输入达15m l/kg行高容量血液稀释,分别监测记录基础值(T0)、诱导后插管前(T1)、插管后即刻(T2)、插管后5m in(T3)、10m in(T4)、20m in(T5)、切皮前(T6)的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)。经桡动脉取血测血气、Lac。结果:A组患者诱导前后MAP无显著性差异(P>0.05),B组诱导后MAP显著降低(P<0.05),与同时相A组比较有显著性差异(P<0.05)。A组CVP插管后5m in(T3)与基础值(T0)比较有显著性差异(P<0.05),与同时相B组比较有显著性差异(P<0.05),两组患者HR诱导后减慢(P<0.05)。A组血红蛋白(Hb)、细胞压积(Hct)在血液稀释后显著降低(P<0.05)。两组血气、Lac在血液稀释前后无显著性变化(P>0.05)。结论:适度AHH有利于维持老年患者血液动力学的稳定,而氧代谢改变不明显,值得临床推广。

Objective： To explore the effect of acute hypervolemic hemodilution by using 6% hydroxyethyl starch on arterial pressure and oxygen metabolism in aged patients. Methods ： Forty patients receiving timing - selective abdominal surgery were randomly divided into 2 groups, hypervolemic hemodilution group （ Group A ） and non - hypervolemic hemodilution group （ Group B ）. Patients in Group A were given general transfusion for supplying basic required volume in physiology and lost volume due to fasting, patients in group B were infused 6% hydroxyethyl starch in 7ml/kg by velocity of 25ml/min to induce and hydroxyethyl starch was continually infused to 15ml/kg to make hypervolemic hemodilution. MAAP, HR and CVP were monitored and recorded before induction of anesthesia （ TO, baseline ） ; before tracheal intubation （ T1 ） ; after tracheal intubation immediately （ T2 ）; 5, 10 and 20 min. after iutubation （ T3, T4, T5） and before skin incision （ T6 ）. Blood gas and Lac were determined at the time points mentioned. Results ： No significant difference of MAP was found before and after induction in Group A （ P 〉 0. 05 ） ; MAP was significantly lower after induction in Group B （ P 〈 0. 05 ） and there was significant difference in the comparison of MAP between the two groups （ P 〈0. 05） ; CVP in group A at T3 was significantly different from which at TO （ P 〈 0. 05 ） and there was significant difference in the comparison with group B （ P 〈 0. 05 ）. HR was significantly lower after induction in two groups （ P 〈0.05 ）. Hb and Hct in group A were lower after hemodilution. No significant difference was seen in the comparison of blood gas and Lac between the two groups before and after hemodilution （ P 〉 0. 05 ）. Conclusion ： Moderate AHH was beneficial to maintaining the stability of hemodynatics and there is no much change in oxygen metabolism.