急性高容量血液稀释对肝癌手术病人内环境变化的影响

Effect of preoperative acute hypervolemic hemodilution on acid-base equilibriumand and electrolyte

目的：探讨6%羟乙基淀粉液术前行高容量血液稀释（AHH）对肝癌手术病人内环境变化的影响。方法：ASA Ⅰ-Ⅱ级肝癌患者30例,随机分为试验组（H组）和对照组（C组）,其中H组麻醉诱导前快速输注贺斯15 ml·kg^-1,C组输注乳酸钠林格液,方法同H组。监测MAP、HR和CVP：记录术中出血量和输液量：分别于稀释前（T1）、稀释后即刻（T2）、术毕（T3）、术后第3 h（T4）进行血气分析及检测血清电解质。结果：PH、HCO2^-、BE在T2时间点H组均有所降低,与C组比较有有统计学意义（P〈0.05）;血清Na^＋在T2-T4时间点H组有轻度上升;C组在T2时间点下降,与C组比较有统计学意义（P〈0.05）：H组血浆K^＋在T2、T3时间点与C组比较有统计学意义（P〈0.05）;H组血浆Cl^-在T2时间点升高（P〈0.05）;两组Cl^-于T3、T4时间点均升高（P〈0.05）。结论：AHH对肝癌手术病人机体电解质及酸碱平衡具有一定影响。

Objective： To investigate the effect of preoperative acute hypervolemic hemodilution on acid-base equilibriumand and electrolyte. Methods ： Thirty ASA Ⅰ - Ⅱpatients scheduled for selective liver operation were randomized into two groups ： group H （ n = 15 ） included patients infused with hydroxyethyl starch（200/0.5） 15 ml·kg^-1 in 30 min before skinineision and Group C （n = 15） infused with Ringers 15 ml·kg^-1. All patients were operated undergeneral anesthesia combined with epidural anesthesia. MAP, HR and CVP were monitored duringlhe operation, arterial blood gas and electrolyte were measured before and after hemodilution, atthe end of operation, 3th hour after operation. The volume of infusion, blood loss and blood transfusion were recorded during operation. Results ： These variables of PH, HCO3^- and BE in group H decreased significantly at T2 compared with group C （P 〈 0.05） , There was a slightly rise trend of Na ^＋ and Cl^- followed by AHH within group respectively, whereas the rise in group C fell behind the other two groups significantly （ P 〈 0.05）. On the other hand, at T2 ,T3 the decrease of serum K ^＋ in group H shows a significant difference in comparison with group C （P 〈 0.05）. Conclusion ： AHH would influenceacid-base equilibriumand and electrolyte.