摘要
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.
出处
《中国医药》
2010年第2期139-141,共3页
China Medicine
关键词
食管癌
血液稀释
血流动力学
凝血功能
Esophageal neoplasm
Hemodilution
Hemodynamics
Coagulation