不同液体预扩容对围术期患者血红蛋白变化的影响

The effect of different kinds of liquid infusion on hemoglobin level in the perioperative period

目的观察不同液体预扩容后对围术期患者血红蛋白变化的差异并探讨产生该差异的影响因素。方法选择拟行择期手术患者80例,随机均分为4组,分别采用转化糖(T组),林格氏液(L组),羟基淀粉(Q组),聚明胶肽(J组)10 ml/kg进行预扩容,速度为0.4 ml/(kg·min),采用Radical-7监护仪动态监测血红蛋白,比较各组之间预扩容前后其数值变化的差异,并探讨其影响因素。结果预扩容后4组患者的血红蛋白值均降低。胶体组(Q组和J组)降低数值大于晶体组(T组和L组)(P<0.05);晶体和胶体组内比较差异无统计学意义(P>0.05)。对于同种液体,血红蛋白降低数值女性患者大于男性,且该降低幅度与年龄、BMI和扩容前血红蛋白测定值,血清总蛋白呈正相关。结论术前禁食患者使用胶体液预扩容更能及时扩充血容量;使用晶体液预扩容更能及时补充组织液和细胞内液的丢失,围手术期采用连续血红蛋白监测对患者补液个体化有指导意义。预扩容对女性、老年、肥胖、高血红蛋白和高血清蛋白患者的血红蛋白的下降更明显。

Objective To compare the variation range of hemoglobin levels after different liquid infused and discuss its influencing factors. Methods 80 patients were randomly divided into four groups（n=20）, group of invert sugar injection（group T）, group of Riger′ s solution（group L）, group of hydroexythyl（group Q） and group of polyegline（group J）.Radical-7 monitor were used to continuously monitor hemoglobin levels. The variation of hemoglobin levels after intravenous drip, and the influencing factors were discussed. Results The hemoglobin levels in 4 groups of patients were all reduced. Colloidal injection reduced more than Cryatal injection（P〈0.05）. For same liquid, hemoglobin level reduced even more in women than in man; the decreased amplitude was positively correlated with age, BMI, hemoglobin level and total serum protein. Conclusion Using colloid fluid infuse could supply blood capacity immediately and using crystal solution could supply tissue fluid or intra cellular fluid. Continuous hemoglobin level monitoring during perioperative period has guiding significance for transfusion. The hemoglobin level was reduced more for women, elderly, people with overweight, people with higher hemoglobin level and total serum protein.