急性高容量血液稀释对机体应激内环境的影响

Effects of Acute Hypervolemic Hemodilution on Stress Response

目的:探讨急性高容量血液稀释(acute hypervolemic hemodilution,AHHD)对机体应激内环境的影响。方法:选择20例美国麻醉医师协会Ⅰ—Ⅱ级择期行股骨内固定手术患者,按照随机数字表法分为2组,每组各10例。观察组患者麻醉诱导插管10 min后静脉滴注羟乙基淀粉130/0.4氯化钠注射液15 ml/kg实施血液稀释,对照组按生理丢失量静脉滴注乳酸林格液。于术前、血液稀释前即刻、血液稀释后即刻采集静脉血,测定血细胞比容,用高效液相色谱法、化学发光法测血浆肾上腺素、去甲肾上腺素、多巴胺和皮质醇浓度。结果:2组患者均未出现因生理指标异常而剔出者,中心静脉压(central venous pressure,CVP)、平均动脉压(mean arterial pressure,MAP)均在正常范围内。AHHD后,2组患者CVP的差异有统计学意义(P<0.05);2组患者血细胞比容水平的差异有统计学意义(P<0.05);观察组患者皮质醇和儿茶酚胺类激素水平均明显低于对照组,差异均有统计学意义(P<0.05)。结论:AHHD后机体应激激素浓度下降,说明AHHD时并未激发机体应激反应,还有可能会降低应激反应。从机体应激方面而言,实施AHHD是安全的。

OBJECTIVE： To probe into the effects of acute hypervolemic hemodilution（ AHHD） on stress response.METHODS： 20 ASA Ⅰ-Ⅱ patients undergoing elective surgery were selected to be divided into two groups via the random number table,with 10 cases in each. The observation group were infused with hydroxyethyl starch of 15 ml / Kg and sodium chloride injections 130 /0. 4 in hypervolemic hemodilution after induced 10 min,and control group were infused with Ringer＇s solution according the physical loss. Venous blood samples were collected before operation,before and after hypervolemic hemodilution,and HCT were recorded. Plasma epinephrine,noradrenalin,dopamine and serum cortisol concentration were detected by high performance liquid chromatography（ HPLC） and chemiluminescence measurement. RESULTS： There were no abnormal physiological indexes in two groups,and central venous pressure（ CVP）,mean arterial pressure（ MAP） were in normal ranges. After AHHD,there were statistical significance between two groups in CVP and level of HCT（ P〈0. 05）. The cortisol and catecholamine of observation group were significantly lower than that of control group, with statistically significant difference（ P〈0. 05）.CONCLUSIONS： After AHHD,the stress hormone concentrations decreased significantly,which indicates that AHHD is not a stress-producing technique,on the contrary,it may reduce the stress response on body. Therefore,AHHD is safe from the perspective of stress response.