全麻诱导期间急性高血容量血液稀释对高血压患者血流动力学的影响

The Impact of Acute Hypervolemic Hemodilution on Hemodynamics in Patients with Hypertension during the Induction of General Anesthesia

目的探讨高血压患者在诱导期实施急性高血容量血液稀释(AHH)的安全性及对血液动力学的影响。方法腹部择期手术患者60例,随机分为AHH组和对照组。采用4-2-1法则补充基础生理需要量。于麻醉诱导前、血液稀释后即刻测定血红蛋白(Hb)和红细胞压积(Hct)。记录麻醉诱导前(T0基础值)、气管插管前即刻(T1)、气管插管后即刻(T2)、插管后5min(T3)10min(T4)、20min(T5)、切皮前即刻(T6)的平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)。于AHH前即刻、AHH后4h和24h取中心静脉血,测定心肌钙蛋白(IcTnI)、肌红蛋白(MYO)和肌酸激酶同工酶(CK-MB)浓度。结果2组病人年龄、性别比、体质量和基础Hct比较差异均无统计学意义(P>0.05)。AHH组各时点的MAP、HR差异没有统计学意义(P>0.05),T1～T6CVP升高。C组T1～T6的MAP均低于T(0P<0.05),HR组T1～T6时的HR均高于T(0P<0.05),CVP差异没有统计学意义(P>0.05)。结论急性高血容量血液稀释可预防高血压患者麻醉诱导期血液动力学的波动,且安全性良好。

Objective To investigate the impact of acute hypervolemic bemodilution （AHH） on Hemodynamics in patients with hypertension during the induction of general anesthesia. Methods 60 patients with abdominal surgery and hypertension Ⅰ - Ⅲ were. divided into AHH group and the control group. Physiological basic requirements were added by 4-2-1 law. The Hb and Hct were detected before induction of anesthesia and immediately after hemodilution. MAP, HR and CVP were recorded before the induction of anesthesia（T0-based value ）, immediately before the endotracheal intubation（T1）,immediately after intubation （T2）,after intubation 5 min （T3）, 10 min （T4）,20 min （T5） and immediately before skin incision （T6）,respectively. Central vein blood was taken and the concentration of cardiac troponin I（cTnI）, myoglobin（MYO） and CK-MB（CK-MB） were detected before AHH,after 4 h and 24 h of AHH. Results There was no statistical difference in age, sex ratio, weight and basic Hct between the 2 groups （ P 〉 0.05 ）. There was no significant difference in MAP and HR between every point of AHH group（P〉 0.05） and T1-T6 CVP rise. In C group,the MAP of TI-T6 was lower than that of T0＇s（P 〈 0.05）,and HR of T1-T6 was higher than that of T0＇s （ P 〈 0.05 ）, but there was no statistical difference in CVP （ P 〉 0.05 ）. Conclusion The acute hypervolemic hemedilution （ AHH ） can prevent fluctation of Hemodynamics in patients with hypertension during the induction of anesthesia, and offer good security.