6%羟乙基淀粉行急性超容血液稀释对血电解质及酸碱平衡的影响

Effect of Acute Hypervolemic Hemodilution by 6% of HES on Blood Electrolytes and Acid-base Balance

目的探讨6%羟乙基淀粉溶液(HES,200/0.5)行急性超容血液稀释(AHHD)对机体血电解质及酸碱平衡的影响。方法选择20例20～40岁、ASAⅠ～Ⅱ级择期五官科手术插管全麻患者,以6%HES15ml/kg扩容行中度血液稀释。于AHHD前、AHHD后、手术结束时测定Hct、Hb、血电解质及酸碱平衡指标进行比较。结果AHHD后、手术结束时Hct、Hb较AHHD前显著降低,AHHD后Hct、Hb分别下降了23.1%和21.4%,达到中等程度血液稀释状态;AHHD后血K+浓度下降了13.65%,血Ca2+浓度也明显下降了39.80%,但均在正常范围内;AHHD前、后pH值及血Na+浓度变化差异均无统计学意义。结论6%HES溶液行AHHD能有效地使Hct及Hb下降至靶水平,同时维持了机体血电解质的稳定及酸碱平衡,是一种安全有效的AHHD方法。

Objective To investigate the effect of acute hypervolemic hemodilution （AHHD） with 6% of HES on blood electrolytes and acid - base balance. Methods Twenty patients （ ASA Ⅰ - Ⅱ , 20 -40 years old） were selected and scheduled for ophthalmologic and otorhinolaryngologic operation under general anesthesia. They received 6% of HES （15ml/kg） for moderate hemedilution. Arterial blood samples were taken for determination of HCT, Hb, K ^＋ , Na ^＋, Ca^2＋ and pH before and after AHHD, and at the end of surgical operation. Results HCT and Hb significantly decreased after AHHD. HCT and Hb descended respectively by 23.1% and 21.4%, which reached the state of moderate hemodilution. K^＋ and Ca^2 ＋ after AHHD were decreased by 13.65% and 39.80%, respectively, but within mormal limits. The variation of pH and Na ^＋ before and after AHHD had no statistic difference. Conclusion AHHD with 6% of HES can make HCT and Hb decrease to target level effectively, while maintaining the blood electrolyte and acid - base balance, it is a safety and effect method for hemodilution.