不同液体行高容量血液稀释在骨科手术中的应用

Different colloid for hypervolemic hemodilution in patients undergoing bone surgery

目的:比较不同液体用于急性高容量血液稀释的效果。方法:选取ASAⅠ～Ⅱ级择期骨科手术患者45例,分为3组:A组(HES 200/0.5组)、B组(HES 130/0.4组)和C组(乳酸林格液即BES组),每组15例。全身麻醉诱导时,以50 ml/min速度输注HES 200/0.5或HES 130/0.4或BES(容量20 ml/kg),分别记录术前(T0)、稀释后15 min(T1)、术毕(T2)的SP、DP、HR、CVP、电解质值、Hb、Hct以及术中出血、输血量等。结果:A、B组血液稀释后CVP有所增高,但在正常范围内。A、B组T1、T2时点Hb均明显低于T0水平,而C组Hb仅在T2时点低于T0水平。A、B组患者术中尿量明显高于C组。A、B组患者血流动力学较平稳,两组无统计学差异。3组各时点及组间的电解质变化比较,差异无统计学意义。结论:在全身麻醉下的骨科手术中,快速输入胶体可达急性高容量血液稀释,减少术中出血量,血液动力学及内环境稳定,安全可行,优于单纯晶体液扩容效果。

Objective：To compare the effects of using different colloid on acute hypervolemic hemodilution（AHH）. Methods：Forty-five patients（ASA Ⅰ-Ⅱ） undergone selective orthopaedic selective orthopaedic bone surgery were randomly allocated to groups of of A（hydroxyethylstarch;HES 200/0.5）,B（HES 130/0.4） and and C（Lactated Ringer′s solution：BES）（n=15 for each）.Upon induction of general anesthesia,the patients were administered with infusion of either HES 200/0.5 or HES 130/0.4 by 50 ml/min or BES in a dose of 20 ml/kg,and kept regarding the systolic pressure（SP）,diastolic pressure（DP）,heart rate（HR）,central venous pressure（CVP）,electrolyte value,hemoglobin（Hb） and hematocrit value（Hct） before operation（T0）,at 15 min after AHH（T1） and postoperation（T2） as well as intraoperative blood loss and volume of blood transfusion,respectively. Results：CVP was found elevated in group A and B after AHH,though,it remained in normal range.In group A and B,the level of Hb at both T1 and T2 was lower than that seen at T0,and the reduced level was only observed at T2 in group C.Higher intraoperative urinary production was found in group A and B as compared with group C,and yet,the hemodynamics remained relatively stable in both group A and B,which showed no statistical difference.Also,no difference was seen among the three groups concerning the serum electrolyte level at each time point（P〉0.05）. Conclusion：Supplying AHH to patients undergoing bone surgery under general anesthesia block by transfused HES can reduce perioperative blood loss and maintain relatively stable hemodynamics and internal environment,which appears safer and superior to simple crystalloid in correcting fluid balance.