万汶中度急性超容血液稀释对异氟醚肺摄取与排出的影响

THE IMPACT OF VOLUVEN USED IN MODERATE ACUTE HYPERVOLEMIC HEMODILUTION ON ISOFLURANE UPTAKE AND ELIMINATION

目的观察万汶在胸腰椎手术行中度急性超容血液稀释(acute hypervolemic hemodilution,AHH)对异氟醚吸入麻醉肺摄取与排泄的影响。方法选择预计失血量>500mL的择期胸腰椎手术患者80例,ASAⅠ～Ⅱ,随机分为A组(AHH组)和C组(对照组)各40例。A组于麻醉诱导前经中心静脉以50～60mL/min的速度滴注6%中分子羟乙基淀粉130/0.4(万汶)15mL/kg,滴注完毕后以3～5mL/min维持;对照组以3～5mL/min滴注乳酸钠林格液。诱导插管后吸入3%的异氟醚,5min关闭挥发罐。术中维持吸入1%异氟醚并复合静脉靶控输注丙泊酚、瑞芬太尼、维库溴铵维持麻醉。手术结束缝皮完成后停止靶控输注,关闭挥发罐。用Datex气体监护仪监测P_(ET)CO_2和吸入浓度(F_1)、肺泡浓度(F_A)以及终止吸入之前即刻的呼气末浓度(F_(Ao)),比较F_A达到F_1 50%的时间、停止吸入后F_A达到FA_(50)%的时间,并连续记录F_A:F_1、F_A:F_(AO)、PCO_2、气道峰压、患者体温、动脉血红细胞压积。结果 A组患者F_A达到F50%的时间及F_A达到F50%的时间均较C组快(P<0.05);血液稀释后,A组患者动脉血红细胞压积显著低于C组;P_(ET)CO_2、气道峰压及体温2组差异无统计学意义。结论万汶在胸腰椎手术行中度AHH能加快对异氟醚吸入麻醉肺摄取和排出,可能与血液稀释对血液HCT的影响有关。

Objective To observe the impact of Voluven used in moderate acute hypervolemic hemodilution （AHH） on isoflurane uptake and elimination in lung. Methods Eighty patients who underwent elective thoracolumbar spine surgery and the estimated blood loss 〉 500mL, ASA I - 11 were divided into AHH group（group A,n =40） and control group （group C, n = 40）. Group A received 6% hydroxyethyl starch 130/0.4 （Voluven） 15mL/kg intravenous transfusion at a rate of 50 - 60mL/min by central venous before induction of anesthesia. After intravenous transfusion of required dose, the injection was kept by 3 -5mL/min. Group C received lactated Ringer solution intraveneous transfusion at a rate of 3 - 5mL/min. Both group received inhalation of 3% isoflurane for 5 min after tracheal intubation. Inhalation of 1% isoflurane and target controlled infusion of propofol, remifentanil and vecuronium bromide were combined to maintain anesthesia till the surgical suture. PET CO2, Fl, FA and FAO were detected by Datex gas monitor. The time when FA reached 50% FI and FA reached 50% FAO were compared. FA： FI, FA ： FAo, PET CO2, RAWmax, body temperature and HCT were continuously recorded. Results Group A were significantly faster than group C in the time when FA reached 50% Ft and FA reached 50% FAo（P 〈0. 05）. Group A had lower level of HCT than group C （P 〈0.05） after hemodilution. There were no significant differences in PET CO2, RAWmax and body temperature. Conclusion Voluven used in moderate AHH might accelerate isoflurane uptake and elimination in lung,which might be related to the impact of hemodilution on blood HCT.