急性高容量血液稀释对老年食管癌根治术患者血流动力学和凝血功能的影响

Influence of acute hypervolemic hemodilution on hemodynamic and coagulation status of elderly patients with radical resection of esophageal carcinoma

目的评价应用不同液体行急性高容量血液稀释（AHH）对老年食管癌根治术患者血流动力学、凝血功能的影响。方法择期全身麻醉复合硬膜外食管癌手术患者90例，完全随机分为3组：每组30例，麻醉诱导前30min，A组按15～20ml／kg，以20ml／min速率静脉滴注6％羟乙基淀粉（200／0．5）；B组以同样的剂量、速率静脉滴注6％羟乙基淀粉（130／0．4）；C组静脉滴注乳酸钠林格液。分别记录AHH前（t．）、插管即刻（t2）、插管后10min（t3）、AHH后10min（t4）、手术3h（t5）、手术结束（t6）的MAP、CVP、HR和各时间点的Hb、Hct、Pit、PT、APTT及FIB的变化。结果血流动力学：组内与AHH前（t1）比较，A、B组在t4、t5时点CVP、MAP显著升高，差异均有统计学意义；Hct显著下降；A、B组在t4、t5与c组比较，CVP、MAP升高，Hct下降，差异均有统计学意义（P〈0．05）。凝血功能变化：组内与t。相比，A、B组P1t在t3、t4、t5时点显著下降；C组无明显变化；PT、APTT明显延长，FIB亦明显下降，而C组仅在t5时点延长或下降，差异均有统计学意义（均P〈0．05）；A、B组在t4、t5与C组比较差异均有统计学意义（均P〈0．05）。而A、B组之间血流动力学与凝血功能差异均无统计学意义。C组术中输液、输血量显著高于A、B组（t分别为2．99、24．63、3．58、24．20，均P〈0．01）。结论6％羟乙基淀粉（200／0．5）和6％羟乙基淀粉（130／0．4），AHH对老年食管癌手术循环稳定、凝血功能抑制轻，减少输血量，节约血源。

Objective To evaluate the influence of acute hypervolemic hemodilution （AHH） on hemodynamic and coagulation status of elderly patients with radical resection of esophageal carcinoma. Methods Ninety patients aged 60 - 89 years undergoing elective esophageal carcinoma surgery under general anesthesia combined with epidural analgesia were randomly divided into 3 groups （ n = 30 ）. 30 minutes before anesthesia, group A was given 6% HES（200/0.5） 15 -20 ml/kg, 20 ml/min; group B was given 6% VOLUVEN（ HES 130/0.4） ; group C was given sodium lactate Ringer＇s solution. Mean arterial pressure （ MAP）, central vein pressure （CVP） and heart rate （HR） were recorded before AHH（ t1 ） , at intubation （t2 ） , 10 minutes after intubation（ t3 ） , 10 minutes after AHH（ t4 ） , 3 hours after operation began（ t5 ） and at the end of operation （ t6 ）. Changes of H6, Hct, PLT, PT, APTT and FIB were recorded. Result The levels of CVP, MAP increased （ P 〈 0.05 ） in group A and B, and Hct decreased. As for coagulation function, PT, APTT, FIB either prolonged or decreased （P 〈0.05） at tl; at t3 and t4, PCT decreased obviously（ P 〈 0.01 ）. There was not significant difference of hemodynamic and coagulation be- tween Group A and B. （ P 〉 0.05 ）. Volume of liquid and blood transfusion during operation in Group C was higher than that in Group A and B. Conclusion AHH can effectively maintain hemodynamic stability and reduce blood transfusion.