6%羟乙基淀粉等容血液稀释对非体外循环冠状动脉旁路移植术患者内环境与氧代谢的影响

The influences of acute normovolemic hemodilution of hydroxyethyl starch 130/0.4 on internal environment and oxygen metabolism during off-pump coronary artery bypass surgery

目的：评价急性等容血液稀释（ANH）对非体外循环冠状动脉旁路移植术（CABG）患者内环境与氧代谢的影响。方法：选择非体外循环CABG患者60例,年龄40~70岁,体质量50~100kg,采用随机数字表法,分为两组（每组n=30）,对照组（C组）和ANH组。ANH组于麻醉诱导平稳后经中心静脉重力放血,将红细胞压积（Hct）稀释到30%,同时以与采血速率（15~25m L/min）相同的速率输注等容量6%羟乙基淀粉130/0.4氯化钠注射液,ANH过程持续时间为15~25min。于ANH前、ANH后5,30,60及120min,自体血输注完毕后10和60min时采集桡动脉和肺动脉血样行血气分析,记录Hb,pH值,乳酸、Pa O_2和血浆渗透压,同时经肺动脉导管监测数据,记录混合静脉血氧饱和度（Sv O_2）,计算氧供（DO_2）、氧耗（VO_2）,氧摄取率（O_2ER）及动,静脉血氧含量差（Ca-v O_2）。结果：与C组比较,ANH组Sv O_2、O_2ER及Pa O_2升高,Hb和血浆渗透压降低（P〈0.05）,DO_2、VO_2、Ca-v O_2、p H值和乳酸水平,差异无统计学意义（P〉0.05）。结论：6%羟乙基淀粉130/0.4等容血液稀释对非体外循环CABG患者内环境与氧代谢无明显影响。

Objective： To evaluate the influences of acute normovolemic hemodilution on internal environment and oxygen metabolism during off-pump coronary artery bypass surgery（ OPCABG）. Methods： Using random number table method,sixty patients（ aged 40 to 70 years old,weight 50-100kg） scheduled for off-pump coronary artery bypass surgery were randomly assigned to an ANH group（ group A,30 patients） or a control group（ group C,30 patients）. In group A,after anesthesia induction,blood was withdrawn from a central vein by gravity,and the hematocrit（ Hct） was diluted to 30%,in parallel,Hydroxyethyl Starch 130 /0. 4 was infused to maintain normovolemia,and group C were not given ANH as the controls. The radial arterial and lung arterial blood gas（ Hb,Lactate,Pa O2,Colloid osmotic pressure） and Sv O2 were recorded at 5 minutes after induction; 5、30、60、120 minutes after completion of ANH and 5 minutes,60 minutes after completion of infusion of autoblood,meanwhile,DO2,VO2,O2 ER,Ca-v O2 were recorded by oxygen uptake kinetics formula. Results： Compared to group C,Sv O2,Pa O2,O2 ER was higher. The hemoglobin of group A was significantly lower. Conclusion： Moderate ANH have minimal impact on the environment and oxygen metabolism,and can be used in OPCABG safely.