不同羟乙基淀粉溶液急性扩容性血液稀释对血流动力学的影响

Comparision of Effects of Hydroxyethyl Starch 130/0.4(HES) and HES 200/0.5 Used for Acute Hypervolemic Hemodilution on Hemodynamic

目的比较6%羟乙基淀粉130/0.4(万汶,Voluven)和6%羟乙基淀粉200/0.5(贺斯,HAES-Steril)用于神经外科患者急性扩容性血液稀释对血流动力学的影响。方法选择行择期神经外科手术患者40例,分为万汶组(V组,n=20)和贺斯组(H组,n=20),分别于麻醉诱导后以500ml/30min速度输注万汶和贺斯1500ml行急性扩容性血液稀释。分别在血液稀释前(T0)、输液1000ml(T1)、1500ml即刻(T2),血液稀释后30～60min(T3)时用经食管超声多普勒HemosonicTM100测定心输出量(CO)、降主动脉血流量(ABF)、主动脉血流加速度(Acc)、峰值流速(PV)、左室射血时间(LVETi)、每搏输出量(SV)值及全身血管阻力(TSVR);分别于相应时间点记录平均动脉压(MAP)及心率(HR)。结果随着输液量的增加,两组CO、ABF、SV、LVETi明显提高(P<0.05),TSVR明显下降(P<0.05),而MAP、HR、PV、Acc各点之间无明显改变(P>0.05),各血流动力学参数的变化两组之间无统计学意义(P>0.05)。结论贺斯和万汶应用于急性扩容性血液稀释,均增加心输出量,血液动力学稳定,其扩容效力相同。

Objective To compare the effects of HAES-Steril with Voluven on hemodynamic and coagulation during acute hypervolemic hemodilution （AHH） in neurosurgical patients.Methods Totally 40 patients undergoing neurosurgy were allocated into HEAS-Steril group （H,n=20） and Voluven group （V,n=20）.Patients were infused 1500ml HAES-Steril or Voluven respectively with 500ml/30min after the anesthesia induction.Cardiac output （CO）,aortic blood flow （ABF）,stroke volume （SV）,peak velocity （PV）,peak acceleration （Acc）,left ventricular ejection time index （LVETi） and total systemic vascular resistance （TSVR） were measured and recorded using HemosonicTM100 before infusion（T0）,at the end of infusion 1000ml（T1） and 1500ml（T2）,and 30～60 min after hemodilution（T3）,respectively.Results After hemodilution,CO,ABF,SV,LVETi increased significantly,while TSVR decreased markedly （P0.05）,and MAP,HR,PV,Acc remained stable.There were no statistic differences in the changes of all hemodynamic parameters between two groups.Conclusion Preoperative acute hypervolemic hemodilution with HAES-Steril or Voluven have the same effects on the hemodynamics.