老年患者急性高容量血液稀释联合尼卡地平控制性降压的可行性研究

Study on the feasibility of acute hypervolemic hemodilution combined with control of hypotension with nicardipine on hemodynamics in elderly patients

【目的】观察中老年患者术中急性高容量血液稀释(acute hypervolemic hemodilution,AHH)联合尼卡地平控制性降压(controlled hypotension,CH)时血液动力学变化,评价其应用于老年患者的可行性。【方法】选择肝脏及胰十二指肠ASAII级手术患者30例,中年组15例,老年组15例,在麻醉诱导后手术开始前以30ml/min的速率输入6%羟乙基淀粉15ml/㎏,在AHH同时以平均动脉压(MAP)的70%为目标用尼卡地平行CH。分别于AHH前即刻(T0)、AHH完成即刻(T1)、AHH完成后30min(T2)、60min(T3)记录血红蛋白(Hb)、红细胞比容(Hct)及血液动力学指标。【结果】(1)两组在T0各指标的差异无统计学意义(P>0.05)。(2)Hb、Hct:与T0相比,两组患者在T1、T2、T3的Hb、Hct均下降(P<0.05),两组间Hb、Hct差异无统计学意义(P>0.05)。(3)血液动力学:与T0相比:两组T2、T3的心率(HR)、心脏指数(CI)、心排血量(CO)、中心静脉压(CVP)上升(P<0.05),MAP、周围血管阻力(SVR)下降(P<0.05);与中年组相比,老年组在T2、T3时的CI、CO下降(P<0.05),CVP上升(P<0.05),MAP、HR、SVR差异无统计学意义(P>0.05)。【结论】对于65岁以上、ASAII级,无明显心肺疾患的老年患者行腹部手术时,按照本研究所用急性高容量血液稀释的速率及水平,尼卡地平控制性降压的标准和时间,能维持机体血液动力学相对稳定,临床上具有可行性。

[Objective] To investigate the effects of acute hypervolemic hemodilution（AHH）combined with control of hypotension（CH）with nicardipine on hemodynamics in middle-aged patients and eldly patients,and evaluate its feasibility in clinical use.[Methods] Thirty ASA II patients（17 male,13 female）were enrolled in this study,15 middle-aged patients aged 40～59 years,15 eldly patients aged 65～79 years,In both groups,compound sodium aceteta injection 10 ml/kg was infused after enterring operation room.6% HES（200/0.5）15ml/kg,at rate of 30 ml/min was infused before skin incision.Nicardipine was infused at a rate of 1～4μg·（kg·min）-1 as soon as AHH began,and maintained MAP at 70% of the preoperative leavel.Hb,Hct,CO,CI,SVR,CVP,MAP,HR and blood gases were monitored and recorded before AHH（T0）,AHH end（T1）,AHH end 30 min（T2）,AHH end 60 min（T3）.CO,CI,SVR,CVP,MAP,HR were monitered at T2,T3.[Results]（1）Two groups were no statistical significance regard to and the values at T0.（2）Hb、Hct：Compared with the value at T0,Hb、Hct were decreased in both groups（P0.05）,Hb、Hct were no statistical significance between both groups（P0.05）,（3）Hemodynamics index：Compared with the value at T0,HR、CI、CO、CVP were increased（P0.05）,MAP 、SVR were decreased（P0.05 in both groups,Compared with middle-aged group,CI、CO were decreased（P0.05）,CVP was increased（P0.05）at T12 、T3,MAP 、HR、SVR were no statistical significance（P0.05）in elderly patient group.[Conclusion] Hemodynamics can be maintain relatively stable in AHH combined with CH induced by nicardipine,it can be used as a way of blood conservation in elderly patients.