羟乙基淀粉130/0.4和聚明胶肽行急性高容量血液稀释对开胸手术患者血流动力学的影响

Effect of Preoperative Acute Hypervolemic Hemodilution with HES 130/0.4 and Polygeline on Hemodynamics in Undergoing Thoracotomy Patients

目的探讨羟乙基淀粉130/0.4和聚明胶肽急性高容量血液稀释对开胸手术患者血流动力学反应的影响和开胸、关胸前后血流动力学的基本变化规律。方法择期开胸手术患者60例,ASAⅠ级或Ⅱ级,年龄20～65岁,体重45～70kg,随机分为3组(n=20):羟乙基淀粉130/0.4组(A组)、聚明胶肽组(B组)和对照组(C组)。3组患者入手术室后,开通外周静脉,以20ml/(kg.h)的速度,分别给予6%中分子羟乙基淀粉130/0.4、5%聚明胶肽和乳酸林格液扩容1h。然后3组再以10ml/(kg.h)继续输注乳酸林格液维持。记录3组患者麻醉诱导前、开胸前5min、开胸后10min、关胸前5min、关胸后10min时的BP、HR。计算收缩压(SBP)与心率(HR)的乘积(RPP)。记录各组SBP、HR的变化幅度大于基础值30%,RPP>22000的发生情况。同时记录中心静脉置管后、开胸前5min、开胸后10min、关胸前5min、关胸后10min中心静脉压的变化。结果与基础值比较,开胸前后和关胸前后乳酸林格液组血流动力学的变化比较明显(P<0.05),而HES130/0.4和聚明胶肽组的指标变化相对稳定;与对照组比较,HES130/0.4和聚明胶肽组的CVP于开胸、关胸前均明显升高,血压却较稳定,仅开胸前5minHES130/0.4组SBP高于对照组(P<0.05);与开胸前比较,开胸后10min3组心率、CVP均增高(P<0.05);与开胸后10min比较,关胸前5min3组SBP、DBP、CVP均降低(P<0.05)。结论羟乙基淀粉130/0.4和聚明胶肽于术前行急性高容性血液稀释可以使开胸手术患者术中血流动力学更加稳定,提高患者对失血的耐受性。

Objective To investigate the effect of preoperative acute hypervolemic hemodilution with 6% hydroxyethyl starch 130/ O. 4 （HES130/0.4）and polygeline on hemodynamic response and variance regularity of hemodynamic response in open - and close - tho- racic cavity in undergoing thoracotomy patients. Methods Sixty patients undergoing thoracotomy,ASA physical status I or I ,aged 20 65 yeansold,weighing 45 - 70kg, were randomly divided three group： HES130/0.4 group （ group A, n = 20） , Polygeline group （ group B ,n = 20） and Ringer＇s solution group （group C, n = 20）. They were respectively infused 20ml/ （kg · h） with HES130/0.4, polygeline and Ringer＇s solution in one hour before infuseing followed Ringer＇s 10ml/ （kg · h）. The Blood Pressure （BP） and heart rate （HR） were recorded. RPP was calculated before induction（baseline） , 5min before and l0 min after open thoracic cavity, 5min before and lOmin after close thoracic cavity. And central venous pressure （CVP） was measured at immediately after deep venous puncture , 5min before and 10min after open thoracic cavity, 5rain before and 10min after close thoracic cavity. Results The changes of hemodynamies in Ringer＇s solution group in operation were obvious as compared with baseline before operation. HES130/0.4 and polygeline were relatively stable. Two groups had no significant difference. The CVP of HES130/0.4 and polygeline groups increased obviously before and after open thoracic cavity, but the blood pressure was relatively stable. Only systolic blood pressure increased obviously as compared with Ringer＇s solution group at 5min before open thoracic cavity. At 10min after open thoracic cavity,HR and CVP in three groups increased obviously as compared with 5 min before open thoracic cavity. At 5 min before close thoracic cavity, blood pressure and CVP in three groups de- creased obviously as compared with 10 min after open thoracic cavity. Conclusion The preoperative acute hypervolemic hemodilution with HES 130/0.4 and polygeline in undergoing thoracotomy patients can keep hemodynamics more stable and improve tolerance of patients to withstand hypovolemics.