进口和国产琥珀酰明胶急性等容血液稀释对围手术期病人电解质影响的研究

Electrolytes Changes in Response to Acute Normovolemic Hemodilution with Imported and Domestic Succinyi Gelatin in Perioperative Patients

目的用进口和国产琥珀酰明胶分别行急性等容血液稀释（ANH），观察其对围手术期病人生命体征、电解质的影响，为临床应用提供依据。方法60例围手术期病人，随机分为3组，每组20例，采用静吸复合全麻。S、G组进行ANH，动脉放血同时经中心静脉输入稀释液：S组为长源雪安＋乳酸林格氏液（平衡液），G组为佳乐施＋平衡液，晶／胶比均为2：1，放血量V=TBV×（Ho．Hf）／Hav，并于失血量大于循环血量的20％或预计Hct〈24％时予以回输。C组不进行血液稀释，所输液体为平衡液。3组均可在必要时输异体血。监测HR、MAP、CVP、SpO2、ST-T；检测ANH前、后电解质和动脉血气；记录术中失血、输血量及尿量。结果各组HR、CVP、BP，SpO2在各时点的变化均在正常范围内；动脉血气变化无统计学意义（P〉0．05）。血液稀释组ANH前后Na^＋无明显变化（P〉0．05）、CI^-略上升（P〉0．05）、Ca^2＋下降（P〉0．05）；K^＋在T1、T2降低（P〈0．05），T3回复接近T0水平，所有变化在正常范围内。3组失血量无明显差别；异体血输入量血液稀释组间无明显差别，与C组比较有统计学意义（P〈0．01）。结论进口和国产琥珀酰明胶急性等容血液稀释对围手术期病人的血流动力学和电解质影响不大，可以明显减少异体血输入，是安全有效的血液保护措施。但在使用利尿剂和胰岛素的情况下，大剂量快速输注时应注意Ca^2＋、K^＋的变化，避免发生低钙血症和低钾血症。因国产琥珀酰明胶长源雪安价格远远低于进口琥珀酰明胶佳乐施，在临床上使用前景更为远大。

Objective To employ imported and domestic succinyl gelatins for acute normovolemic hemodilution （ANH） and observe the effect of ANH on vital sighs and electrolytes of perioperative patients so as to provide basis for further clinical application.Methods A total of 60 perioperative patients were randomly and equally divided into 3 groups.All patients were treated with intravenous-inhalation general anesthesia.ANH was succinylated gelatin injection plus lactated Ringer＇s solution （balanced solution） in group S and gelofusine plus balanced solution in group G, with ratio of crystal to gelatin of 2：1.Blood letting volume=TBV × （Ho-Hf）/Hav and the blood was salvaged when blood loss volume was over 20% of circulation volume or when Hct〈24%.Group C was only given with balanced solution.Extracorporeal blood was transfused in three groups if possible.HR,MAP,CVP,SpO2 and ST-T were monitored and electrolytes and arterial blood gas detected before and after ANH.In the meantime,blood loss, transfusion volume and urinary volume were recorded during operation.Results Changes of HR,CVP,BP and SpO2 at different time points in three groups were at normal range,with no statistical difference upon arterial blood gas （P〉0.05）.There found insignificant change ofNa^＋ before and after ANH in groups C and G （P〉0.05）,minor increase of Cl^- （P〉0.05） and decrease of Ca^2＋ （P〉0.05）.K^＋ was decreased at T1 and T2 （P〈0.05） but recovered at T3 to T0, with all changes at a normal range.No obvious difference was found among three groups.Extracorporeal blood transfusion was similar in groups S and G,with statistical difference compared with group C （P〈0.01）.Conclusions ANH with imported and domestic succinyl gelatin exerts little effect on hemodynamics and electrolytes of perioperative patients and can markedly reduce extracorporeal blood transfusion, which is safe for protection of the blood.At the same time, we should pay attention to changes of Ca^2＋ and K^＋ during fast large dose of blood transfusion under condition of utility of diuretic agent and insulin in order to prevent hypocalcemia and kaliopenia.Domestic succinyl gelatin has a better prospect of clinical application than imported one mainly due to its cheapness.