急性高容量血液稀释对中老年腰硬麻醉患者血流动力学及凝血功能的影响

Influence of acute hypervolemic hemodilution on the hemodynamic changes and blood coagulation function in middle and elderly patients with combined spinal and epidural anesthesia

目的探讨应用6%新型羟乙基淀粉(HES)130/0.4行急性高容量血液稀释(AHH)对腰硬麻醉患者血流动力学及凝血功能的影响。方法选择择期手术并施行腰硬麻醉的中老年患者136例,随机分为R1组和R2组,每组68例。R1组麻醉前输注500 mL乳酸林格液,R2组输注500 mL 6%HES 130/0.4。记录2组患者AHH前(t0)、AHH即刻(t1)、AHH结束后30 min(t2)及AHH结束后60 min(t3)的血流动力学指标和凝血功能指标。结果与t0时间点比较,2组CVP、HR和MAP在t1时间点均有明显波动(P<0.05或P<0.01),但R2组的CVP和MAP水平明显高于R1组(P均<0.01)。且R2组在t2时间点的MAP水平明显高于R1组和t0时间点(P均<0.01)。与t0时间点比较,2组凝血功能指标APTT和PT均有延长,但仍在正常范围内,且2组所有凝血功能指标比较差异无统计学意义(P均>0.05)。结论麻醉前输注6%HES 130/0.4能有效预防中老年患者麻醉期的低血压症状,改善其血流动力学和凝血功能,提高手术疗效和安全性,值得临床推广应用。

Objective It is to explore the influence of acute hypervolemic hemodilution（ AHH） with 6% novel hydroxyethyl starch（ HES） 130 /0. 4 on the hemodynamic changes and blood coagulation functions in middle and elderly patients with combined spinal and epidural anesthesia. Methods A total of 136 middle and elderly patients underwent combined spinal and epidural anesthesia on elective day were randomly divided into R1 group and R2 group,68 cases for each group. R1 group was injected with 500 mL lactated Ringer＇s solution and R2 group with 6% HES 130 /0. 4 before anesthesia. Hemodynamic changes and blood coagulation function before AHH（ t0）,immediately after AHH（ t1）,30 min after AHH（ t2） and60 min（ t3） after AHH were recorded. Results Compared with the hemodynamic changes in t0,central venous pressure（ CVP）,heart rate（ HR） and mean arterial pressure（ MAP） had markedly changes in T1（ P〈0.05 or P〈 0.01）,and were evidently higher in R2 group than those in R1 group（ P all〈 0. 05）. Additionally,R2 group was obviously higher in MAP level in t0 than R1group and the difference was significant（ P〈0.01）. Compared with the blood coagulation function changes in t0,though activated partial thromboplastin time（ APTT） and prothrombin time（ PT） had slight prolonged,but they were still in normal ranges,and there was no significant difference between the two groups in blood coagulation function changes（ P〈0.05）. Conclusion AHH with 6% HES 130 /0. 4 before anesthesia can effective prevent low blood pressure symptoms in middle and elderly patients during anesthesia,improve hemodynamic changes and blood coagulation functions and promote surgical efficacy and safety,it is worth to be widely used in clinic.