4%琥珀酰明胶高容血液稀释对脑氧供需平衡的影响

Effects of gelofusine hypervolemic hemodilution on the balance of cerebral oxygen supply and demand

目的探讨高容血液稀释对脑氧供需平衡的影响。方法40例ASAⅠ～Ⅱ级胸科手术患者,随机分为高容血液稀释组(A组)和对照组(B组)。分别于T1(气管插管后)、T2(血液稀释后)和T3(气管拔管后)3个时点采集颈静脉球部和桡动脉血,行血气分析和血乳酸浓度测定,并计算动脉、颈静脉血氧含量(CaO2、CjvO2)、颈内动静脉血氧含量差C(a-jv)O2。结果两组T2时点SjvO2与T1和T3比较差异无统计学意义(P>0.05);T2时点C(a-jv)O2和血乳酸浓度与T1和T3比较差异无统计学意义(P>0.05)。A组(血液稀释组)术中实际失血量和实际输血量均少于对照组(P<0.05)。结论高容血液稀释用于胸科手术对脑氧供需平衡无影响,可有效减围术期实际用血量,临床应用切实可行。

Objective To study the effects of gelofusine hypervolemic hemodilution on the balance of cerebral oxygen supply and demand. Methods Forty patients, being rated as ASA Ⅰ - Ⅱ and undergoing thoracic surgery, were randomly divided into two groups ,i. e. group A（ hypervolemic hemodilution） and group B（ control group）. At the three time points of T, （ after intubation）, T2 （after hemodilution） and T3 （after extubation ）, blood samples from the radialartery and jugular bulb were collected and measured, blood gas and concentration of blood lactic acid and were eomputered for CaO2, SjvO2 and C （ a - jv）O2. Results The amounts of SjvO2 at T2 had no remarkable differences compared with that at T1 and T3 with the two groups（ P 〉0.05） ;and the amounts of CaO2 and C （a- jv）O2 at T2 had no remarkable difference compared with that at T1 and T3 （ P 〉 0.05 ）. The amounts of blood loss and blood transfusion with group A were less than that with group B in perioperation （ P 〈 0.05 ）. Conclusion Gelofusine hypervolemic hemodilution have no effect on the balance of cerebral oxygen supply and demand, and the amounts of blood transfusion can be effectively reduced.