急性等容血液稀释对心脏手术病人血液动力学、氧供、氧耗和脑氧合的影响

Effects of acute normovolemic hemodilution on hemodynamics, oxygen delivery/consumption and cerebral oxygenation during cardiac surgery

目的:了解急性等容血液稀释对心脏直视手术病人可能产生的影响,以指导其在体外循环中的应用。方法:观察16例ASA Ⅱ～Ⅲ级择期心脏直视手术病人,接受体外循环前实施急性等容血液稀释,监测病人血液动力学、氧供、氧耗、乳酸浓度及颈内静脉血氧饱和度等指标的变化。结果:血液稀释后病人的心指数增加了15.5%,氧供和氧耗无显著变化,氧摄取率无显著变化。颈内静咏血氧饱和度、动脉血乳酸浓度及颈内静脉血乳酸浓度无明显改变。结论:急性等容血液稀释(10ml/kg左右)对于术前血红蛋白浓度正常的心脏手术病人安全有效。

To investigate the effects of acute normovolemic hemodilution (ANHD) on hemodynamies. oxygen delivery/consumption and cerebral oxygenation during cardiac surgery. Method:In 16 patients (ASA gradeⅡ-Ⅲ) undergoing selective cardiac surgery, ANHD was accomplished by colloid solution(10ml/kg body weight ) after induction of anesthesia. The hemodynamics, oxygen delivery/eonsumption.lactate concentration and internal jugular venous blood oxygen saturation were monitored during the surgery. Result: After ANHD the cardiac index (CI) increased by 15.5%(P<0.05). oxygen delivery/consumption and oxygen extraction ratio did not change. Internal jugular venous blood oxygen saturation and lactate concentration of both arterial and internal jugular venous blood did not change. Conclusion: ANHD(10ml/kg body weight) after induction is a safe and effective technique of autotransfusion for cardiac surgery patients with normal hemoglobin level before operation.