急性高容量血液稀释对全髋关节置换术患者血浆杀菌／通透性增加蛋白表达的影响

Effect of acute hypervolemic hemodilution on expression of plasma bactericidal/permeability-increasing protein in patients undergoing total hip replacement.

目的探讨羟乙基淀粉急性高容量血液稀释对全髋关节置换术患者血浆杀菌／通透性增加蛋白（BPI）表达的影响。方法选择ASAⅠ、Ⅱ级择期行全髋关节置换术患者20例，随机分为羟乙基淀粉组（HES组）和乳酸钠林格液组（LR组），每组各10例。20例患者均采用腰麻-硬膜外联合麻醉，于麻醉后，以20ml／kg的剂量和30mE／（kg·h）的速率分别输入6％HES和LR。分别记录手术时间、术中出血量和输血量。分别在麻醉前（T0）、手术开始前（T1）、手术开始后30min（T2）、手术结束（T3）时采外周静脉血测定BPI含量。结果HES组术中出血量[（560±90）ml]、输血量[（200±100）ml]显著少于LR组[（810±110）ml与（600±200）ml，t分别为5．562和5．657，P均〈0．001]。HES组T2、T3时BPI浓度为（8．9±1．6）μg／L和（13．4±1．2）μg/L，显著高于麻醉前[（4．9±1．2）μg/L，P均〈0．05）]。LR组T2、1、3时BPI浓度为（7．3±1．2）μg/L和（9．9±0．8）μg/L，明显高于麻醉前[（5．0±1．1）μg/L，P均〈0．05]，HES组T2、T3时BPI浓度明显高于LR组（t分别为2．530和7．674，P分别为0．021、0．001）。结论全髋关节置换术患者用羟乙基淀粉进行急性高容量血液稀释，不仅可以减少术中输血，而且可以有效提高血浆BPI浓度，有利于机体免疫功能的稳定。

Objective To study the effect of acute hypervolemic hemodilution on expression of plasma bactericidal/permeability-increasing protein （BPI） in patients undergoing total hip replacement. Methods Twenty ASA Ⅰ - Ⅱ patients undergoing elective total hip replacement were randomly divided into two groups （n = 10 for each） ：HES group and LR group. The patients in HES group received 6% HES 20 ml/kg in rate of 30ml/（kg . h） after anesthesia. The patients in LR group received Ringer＇s solution 20 ml/kg in rate of 30 ml/（ kg . h） after anesthesia. The blood loss, blood transfusion and the time of operation were recorded. Venous blood samples were taken before anesthesia （ T0 ）, at the begining of operation （ T1 ） ,30 ruin after operation （ T2 ）, and at the end of operation （T3） for determination of plasma bactericidal/permeability-increasing protein. Results The blood loss and the blood transfusion in HES group were significantly lower than that of LR group [ blood loss： （560 ± 90）ml vs （810 ± 110） ml and blood transfusion ： （200 ± 100） ml vs （600 ± 200） ml, t = 5. 562 and 5. 657, P 〈 0. 001 ]. The plasma BPI concentrations in HES group were significantly increased at T2 - T3 as compared to baseline value at TO [ （8.9 ± 1.6） μg/L, （ 13.4 ± 1.2） μg/L and （4.9 ± 1.2 ） μg/L, P 〈 0.05 ]. The plasma BPI concentrations in LR group were significantly increased at T2 - T3 as compared to baseline value at TO [ （7.3 ± 1.2） μg/L, （9.9 ± 0.8 ）μg/L and （5.0 ± 1.1 ） μg/L, P 〈 0.05 ], but were lower than those in HES group （ t = 2. 530 and 7. 674, P = 0.021 and 0.001 ）. Conclusion Acute hypervolemic hemodilution with 200/0.5 hydroxyethyl starch can reduce blood transfusion during total hip replacement operation and also can increase the BPI level which would beneficial for the immunological function.