高渗羟乙基淀粉行急性等容血液稀释对患者血流动力学、动脉血气及凝血功能的影响

The effect of acute normovolaemic hemodilution with hypertonic sodium chloride hydroxyethyl starch injection on hemodynamics,blood gas analysis and coagulation

目的:探讨高渗氯化钠羟乙基淀粉40和羟乙基淀粉130/0.4行急性等容血液稀释(Acute normovolaemic hemodilution,ANH)对腰椎融合术患者血流动力学、动脉血气及凝血功能的影响。方法:选择行腰椎融合术的患者50例,随机分为高渗氯化钠羟乙基淀粉组(高渗组)和羟乙基淀粉130/0.4组(对照组),每组25例,行自体血收集的同时回输液体。高渗组:回输0.5倍自体血采集量的高渗氯化钠羟乙基淀粉40注射液;对照组:回输与自体血相等体积的羟乙基淀粉130/0.4氯化钠注射液,采血量根据Gross公式将2组患者经血液稀释后的红细胞压积控制在30%。在ANH前5 min(T_1)、ANH结束后10 min(T_2)、自体血输血前5 min(T_3)、自体血输血结束后10 min(T_4)4个时间点记录患者的心率、平均动脉压,在T_1、T_2、T_4时行动脉血气分析,在T_1、T_4时行血栓弹力图检测。监测2组患者手术时间、术中失血量、术中异体血输注量、术中输液量、术中尿量、术中血管活性药使用情况及并发症发生情况等。结果:在T_3时点,高渗组患者平均动脉压明显低于对照组,差异有统计学意义(P<0.05),其他各时点2组平均动脉压比较差异无统计学意义(P>0.05)。高渗组9例(36.0%)术中使用了血管活性药,对照组2例(8.0%)术中使用了血管活性药,差异有统计学意义(P<0.05)。高渗组患者术中尿量明显多于对照组,差异有统计学意义(P<0.05)。2组患者动脉血气分析和血栓弹力图相关参数比较,差异均无统计学意义(P>0.05)。结论:对腰椎融合术患者使用高渗氯化钠羟乙基淀粉40和羟乙基淀粉130/0.4行急性等容血液稀释均安全可行,具有一定的血液保护效应。术中行ANH应根据不同液体的理化性质加强对容量的监测和管理。

Objective:To investigate the effects of Acute normovolaemic hemodilution(ANH)with hypertonic sodium chloride hydroxyethyl starch 40 and hydroxyethyl starch 130/0.4 on hemodynamics,arterial blood gas and coagulation in patients undergoing lumbar fusion.Methods:Fifty patients undergoing lumbar fusion were randomly divided into hypertonic sodium chloride hydroxyethyl starch group(Hyperosmotic group)and hydroxyethyl starch 130/0.4 control group(Control group),with 25 cases in each group.The patients in hyperosmotic group were given hypertonic sodium chloride hydroxyethyl starch 40 injection with 0.5 times the volume of autologous blood collection,and those in control group were given hypertonic sodium chloride hydroxyethyl starch 40 injection with 0.5 times the volume of autologous blood collection.The same volume of autologous blood was infused with hydroxyethyl starch 130/0.4 sodium chloride injection,and the hematocrit of the two groups was controlled to 30%after hemodilution according to the Gross formula.Heart rate(HR)and mean arterial pressure(MAP)were recorded at 5 min before ANH(T1),10 min after the end of ANH(T2),5 min before autologous blood transfusion(T3)and 10 min after the end of blood transfusion(T4).Arterial blood gas analysis was performed at T1,T2 and T4,and thromboelastography was performed at T1 and T4.Intra-operative operation time,blood loss,allogeneic blood infusion volume,infusion volume,urine volume,use of vasoactive drugs and complications were monitored in the two groups of patients.Results:At time T3,the mean arterial pressure of patients in the hypertonic group was significantly lower than that of the control group,with a statistically significant difference(P<0.05).There was no statistically significant difference in mean arterial pressure between the two groups at other time points(P>0.05).There were 9 cases(36.0%)in the hypertonic group who used vasoactive drugs during surgery,and 2 cases(8.0%)in the control group,with a statistically significant difference(P<0.05).The intraoperative urine output of patients in the hypertonic group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in arterial blood gas analysis and thromboelastography parameters between the two groups of patients(P>0.05).Conclusion:It is safe and feasible to use hypertonic sodium chloride hydroxyethyl starch 40 and hydroxyethyl starch 130/0.4 for mild acute normovolemic hemodilution in patients undergoing lumbar fusion surgery,which has a certain blood protection effect.During ANH,the volume monitoring and management should be strengthened according to the physical and chemical properties of different fluids.