不同血浆代用品急性高容量血液稀释对手术患者血液动力学及肾功能的影响研究

Effects of acute hypervolemic hemodilution with different plasma substitutes on hemodynamics and renal funtion in surgical patients

目的观察不同血浆代用品术前急性高容量血液稀释(AHH)对神经外科手术患者血液动力学及肾功能的影响。方法将60例ASA分级Ⅰ～Ⅱ患者随机分成三组:羟乙基淀粉组(V组)、聚明胶肽组(P组)和平衡液组(R组),每组各20例。麻醉诱导后分别在30min内输入6%羟乙基淀粉、5%聚明胶肽和乳酸林格液20ml/kg,于AHH前(T1)、AHH完成即刻(T2)和AHH后30min(T3)采动脉血1ml立即测定红细胞压积(Hct)、Hb及采集静脉血样监测尿素氮(BUN)、肌酐(Cr)和β2-微球蛋白(β2-MG)在各时间点的变化。连续记录HR、平均动脉压(MAP)和中心静脉压(CVP)。结果扩容率R组低于P组和V组(P<0.05)。V组、P组的CVP在T2[分别为(15.1±3.6)cmH2O、(16.8±3.3)cmH2O]较T1[分别为(8.1±1.9)cmH2O、(8.2±1.9)cmH2O]升高(P<0.01)。与T1比较,三组患者MAP在T2和T3均升高,但差异均无统计学意义(P>0.05)。三组患者HR在AHH期间差异均无统计学意义(P>0.05)。三组BUN、Cr、β2-MG在各时间点组间和组内比较差异均无统计学意义(P>0.05)。结论羟乙基淀粉和聚明胶肽扩充血容量效果好,优于平衡液,血液动力学稳定;羟乙基淀粉、聚明胶肽对肾功能无不良影响,可安全使用于神经外科手术患者。

Objective To observe the effects of acute hypervolemic hemodilution （AHH）with different plasma substitutes on hemodynamies and renal funtion in neurosurgical patients. Methods Sixty ASA Ⅰ - Ⅱ patients undergoing elective neurosurgery were divided into 3 groups（ n = 20 each）：6% hydroxyethyl starch group （Voluven130/0.4） （group V）, 5 % Polygeline group（group P ） and Lactated Ringer＇s solution group（group R）. After induction of anesthesia the patients were randomized to receive 20 ml· kg^-1 of either 6% Voluven, 5% Polygeline or Lactated Ringer＇s solution within 30 rain. Blood samples were taken before （T1）, immediately at （T2） and 30 rain after the end fluid infusion （T3） for determination of hernatoerit （Hct）,hemoglobin（Hh）,urea nitrogen（BUN）,Creatinine（Cr） and β2-mircroglobulin （β2-MG）. And during the hemodilution the heart rate （HR）, mean arterial blood presure （MAP） and central vein pressure （CVP） were continuousely monitored. Results Lactated Ringer＇ s solution was significantly less efficient in expanding intravascular blood volume than the 2 plasma substitutes, but there no significant difference in blood volume expansion rate among group Vand P. In the AHH process three group of patient MAP and HR maintain stable relatively , CVP increased significantly after AHH compared with the baseline value before AHH in group V,P （ P 〈0.01）. There was no significant change in MAP and HR in all three groups. There was no significam change in BUN , Cr and β2-MG. Conclusion Voluven and polygeline are comparable in expanding blood volume and are more effieent than Lactated Ringer＇s solution, hemodynamics is stable; Voluven and polygeline have no influence to the renal funtion and safety handling in neurosurgieal patients.