急性等容血液稀释对法洛四联症矫正术成年患者血流动力学和氧供的影响

Effects of acute normovolemic hemodilution on hemodynamics and oxygen supply in adult patientsundergoing correction of tetralogy of Fallot

目的评价急性等容血液稀释对法洛四联症矫正术成年患者血流动力学及氧供的影响。方法拟行法洛四联症矫正术患者10例，年龄20～59岁，体重41～61 kg ，ASA分级Ⅲ或Ⅳ级。麻醉诱导后待血流动力学平稳且每搏量变异度（SVV）≤10%时行急性等容血液稀释：经股动脉采血，采血量为15%总血容量，体外循环结束后回输。采血的同时采用等容量6%羟乙基淀粉补充。于血液稀释前、血液稀释结束后5 min时记录HR、MAP、CVP、CO、SVV和外周血管阻力；采集血标本测定Hb，并行血气分析，记录SaO2、PaO2和乳酸浓度，计算氧供。结果与血液稀释前比较，血液稀释后CO升高，外周血管阻力和Hb降低（P〈0.05），HR、MAP、CVP、SVV、PaO2、SaO2和氧供差异无统计学意义（P〉0.05）。结论急性等容血液稀释用于法洛四联症矫正术成年患者可增加心输出量，维持氧供和血流动力学平稳。

ObjectiveTo evaluate the effects of acute normovolemic hemodilution （ANH） on hemodynamics and oxygen supply in adult patients undergoing correction of tetralogy of Fallot.MethodsTen consecutive patients, aged 20-59 yr, weighing 41-61 kg, of American Society of Anesthesiologists physical status Ⅲ-Ⅳ, scheduled for elective correction of tetralogy of Fallot, were enrolled in the study.After induction of anesthesia, ANH was performed when hemodynamics was stable and stroke volume variation （SVV） ≤10%.Blood was withdrawn from the femoral artery, the blood collected was expected to be 15% of blood volume, and the shed blood was reinfused after the end of cardiopulmonary bypass.The blood loss was simultaneously replaced with the equal volume of 6% hydroxyethyl starch.Heart rate, mean arterial pressure, central venous pressure, cardiac output, SVV and peripheral vascular resistance were recorded before ANH and at 5 min after the end of ANH.Blood samples were collected for determination of hemoglobin and blood gas analysis, arterial oxygen saturation, arterial oxygen partial pressure and lactate concentrations were recorded, and oxygen supply was calculated.ResultsCompared with the baseline before ANH, cardiac output was significantly increased, and peripheral vascular resistance and hemoglobin were decreased after ANH （P〈0.05）, and no significant change was found in heart rate, mean arterial pressure, central venous pressure, SVV, arterial oxygen partial pressure, arterial oxygen saturation or oxygen supply after ANH （P〉0.05）.ConclusionANH can increase cardiac output and maintain oxygen supply and hemodynamics stable when used for adult patients undergoing correction of tetralogy of Fallot.