术前急性高容量血液稀释对顺式阿曲库铵量效关系的影响

Influence of Pre-operation Acute Hypervolemic Hemodilution on Dose-effect Relationship of Cisatracurium

目的：观察术前急性高容量血液稀释（Acute hypervolemic hemodilution,AHHD）对顺式阿曲库铵量效关系的影响。方法：选择ASAⅠ或Ⅱ级行腹部手术患者60例,随机分成两组：对照组和血液稀释组,每组30例。麻醉诱导前两组患者均静脉滴注乳酸钠林格液7 mL/kg补充禁食禁水所丢失的液体量。血液稀释组患者在麻醉诱导开始时行AHHD,静脉滴注6%羟乙基淀粉注射液（HES130/0.4）15 mL/kg,30 min输完;对照组患者在麻醉诱导开始时静脉滴注乳酸钠林格液2 mL/kg,滴注30 min。用四个成串刺激（Train of Four Stimulation,TOF）监测神经肌肉功能,用单次给药法测定两组患者的顺式阿曲库铵量效关系的变化,在麻醉诱导开始即刻（T0）和30 min后（T1）分别测定动脉血气Hb、Hct、Ca2＋、K＋、Na＋以及血浆总蛋白（TPP）和白蛋白（ALB）浓度。结果：与T0相比,血液稀释组患者T1时点Hb、Hct、TPP、ALB、K＋、Ca2＋、HR均降低（P〈0.05）,CVP升高,差异有统计学意义（P〈0.05）,pH、PaCO2、Na＋无明显变化（P〉0.05）;与对照组T1时点比较,血液稀释组患者T1时点Hb、Hct、TPP、ALB、K＋、Ca2＋均降低（P〈0.05）,而CVP升高（P〈0.05）。对照组患者顺式阿曲库铵ED50、ED90和ED95的95%可信区间分别为47.86（30.90~74.13）、68.39（44.67~104.71）、71.45（46.77~109.65）μg/kg;血液稀释组患者相应的数值为45.70（29.24~73.96）、67.45（42.36~107.15）、70.79（44.67~112.20）μg/kg,两组比较差异无统计学意义（P〉0.05）。结论：采用6%羟乙基淀粉注射液（130/0.4）行AHHD时不改变顺式阿曲库铵的量效关系。

Objective To investigate the influence of acute hypervolemic hemodilution（AHHD） on the dose-effect relationship of cisatracurium. Methods Sixty patients, ASA grade I or II , aged 30 to 60 years,were randomly divided into AHHD group and control group（ n = 30）. All patients were intravenously dripped sodium lactate ringer solution with 7 mL/kg to supply the lost body fluid before induction of anesthesia. The patients in AHHD group were received AHHD firstly, then intravenously dripped 6% hetastarch injection with 15 mL/kg within 30 min. Meanwhile,the patients in control group were intravenously dripped sodium lactate ringer solution -with 2 mL/kg for 30 min before induction of anesthesia. The neuromuscular function of patients was monitored with train-of-four stimulation（ TOF）, the change of dose-effect relationship of cisatracurium was determined with single administration method. The concentrations of arterial blood gas Hb, Hct, Ca2＋ , K＋ , Na＋ , total plasma protein （TPP） and albumin（ALB） were determined at bfore induction （T0 ） and 30 min after induction （T1）, respectively. Results Compared within AHHD group, the levels of Hb, Hct,TPP, ALB, K＋ , Ca2＋ , HR at T1 was significantly decreased than those at T1 （ P 〈 0.05 ）, the level of CVP were significantly increased （ P 〈 0.05 ）, but the value of pH and PaCO2, the level of Na ＋ had no significant difference between two time points （P 〉 0.05）. Compared with control group at T1 , the levels of Hb, Hct,TPP, ALB, K＋ , Ca2＋ of patients in AHHD group were significantly lower, but the level of CVP were significantly higher at Tl （ both P 〈 0.05 ）. The ED50, ED90, ED95 and the homologous 95 % confidence intervals of cisatracurium were 47. 86 （ 30. 9 - 74.13 ） μg/kg,68.39 （ 44.67 - 104.71 ） μg/kg,71.45 （46.77 - 109.65 ） μg/kg in control group and 45.70 （ 29.24 -73.96） μg/kg,67.45（42.36 - 107.15） μg/kg , 70. 79 （ 44. 67 - 112.20）μg/kg in AHHD group,respectively,which had no significant differences between two groups（ P 〉0.05）. Conclusion AHHD with 6% hetastareh injection has no effect on the dose-effect relationship of eisatracurium in patients which underwent abdominal surgery.