急性非等容性血液稀释对靶控输注丙泊酚镇静深度的影响

Effects of acute non-normovolaemic hemodilution on sedation of propofol target controlled infusion

目的观察急性非等容性血液稀释对靶控输注(TCI)丙泊酚镇静深度的影响。方法择期行肝癌切除术患者40例,ASAⅠ或Ⅱ级,随机均分为血液稀释组(A组)和对照组(B组)。A组患者于气管插管完成后开始经桡动脉采血,采血量为血容量的10%。采血完毕后快速静注琥珀酰明胶溶液扩容,有效扩容量为采血量的2倍。于手术结束或Hct<25%时回输自体血,如回输后测得的Hct仍<25%时,则考虑输异体血。术中丙泊酚TCI浓度维持在3μg/ml,间断追加维库溴铵和芬太尼维持肌松和镇痛;B组不采血。分别记录诱导前、诱导后、稀释后、术毕的MAP、HR、Hb和Hct及诱导前、诱导后、稀释后BIS值。结果与诱导前比较,诱导后两组患者MAP明显下降、HR明显减慢(P<0.05);而Hb、Hct差异无统计学意义。与诱导后比较,稀释后A组患者Hb、Hct和BIS值明显下降(P<0.05)。结论急性非等容性血液稀释能加深丙泊酚麻醉深度。

Objective To observe the effects of acute non-normovolemic hemodilution on sedation of propofol target controlled infusion. Methods Forty patients with ASA Ⅰor Ⅱ,underwent selective liver cancer resection were randomly divided into one of the two groups （n=20） group A （acute non-normovolemic hemodilution）and group B （control）. After tracheal intubation, the hemodilution was performed as follow： approximately 10% of blood volume was collected from the radial artery and then double volume of 6% hydroxyethyl starch was infused. The patients in the group B did not receive hemodilution. Auto-blood transfusion was started when the bleeding procedure was finished or Hct was less than 25%. If Hct was still less than 25% after auto-blood transfusion, allogeneic blood transfusion would be considered. During operation, target concentration of propofol was maintained at 3 μg/ml. MAP, HR, Hb, Hct and BIS values were recorded before and after induction, after hemodilution, before blood transfusion and after blood transfusion. Results MAP and HR of the two groups after induction were significantly lower than those before induction（P〈0.05）. Compared with those after induction, Hb, Het and BIS after hemodilution in the group A were decreased significantly（P〈0.05）. Conclusion Acute non-normovolemic hemodilution could significantly reduce the dosage of propofol.