急性扩容性血液稀释的临床研究

Clinical Study on Acute Hypervolemic Hemodilution

目的 :观察羟乙基淀粉用于急性扩容性血液稀释时对机体的影响。方法:将40例ASAI～II级胸科手术患者随机分为2组 ,在静吸复合全身麻醉诱导后 ,分别在30min内从中心静脉快速输入1000mL羟乙基淀粉或乳酸林格氏液 ,同时外周静脉滴注硝酸甘油维持扩容。持续监测有创动脉血压 (ABP)、中心静脉压 (CVP)、心率、血氧饱和度(SpO2)。分别于麻醉前、快速输入羟乙基淀粉或乳酸林格氏液后15min、术毕时抽血查血红蛋白 (Hb)、红细胞压积 (Hct)、血小板(Plt)、血浆电解质 (K +、Na +、Cl- )和凝血谱全套。结果 :与麻醉前比较 ,2组病人在血液稀释后Hb、Hct均显著降低 (P<0.01) ,Plt、血浆电解质 (K +、Na +、Cl- )、凝血酶原时间 (PT)也明显降低 (P<0.05) ,但均在正常生理范围内 ,凝血酶 (部分凝血活酶时间 (APTT)、凝血酶时间 (TT) )无显著性变化(P>0.05)。结论 :羟乙基淀粉应用于急性扩容性血液稀释能有效地维持血液动力学和机体内环境的稳定 ,能防止血液有形成分———血细胞过度丢失 。

Objective:To clinically study acute hypervolemic hemodilution(AHH).Methods:Forty ASA grade I～II patients undergoing thoracic operation were randomly divided into a hygroxyethl starch group(A group)(n=20)and Lactate Ringer's group(B group)(n=20).After general anesthesia inducing,hemodilution was achieved by the internal jugular vein infusion of1000mL of hygroxyethl starch in A group or1000mL of Lactate Ringer's in B group within30minutes.At the same time,SBP was maintained by the peripherally inˉtervenous drip of Nitroglycerin.The levels of ABP,CVP,HR and SpO 2 were continuously monitored.Blood samples were taken before anesthesia,15minutes after infusion of1000mL of hygroxyethl starch in A group or1000mL of Lactate Ringer's in B group and postoperation,to measure Hb,Hct,Plt,serum electrolyte(K + ,Na + ,Cl - )and coagulation parameters(PT,KPTT,TT).Results:After AHH,Hb and Hct significantly deceased(P<0.01)and Plt,serum electrolyte(K + ,Na + ,Cl - )decreased(P<0.05)in both groups,but all data were in the normal physilogic range.The coagulation parameters(PT,KPTT,TT)did not significantly change in both groups(P>0.05).Conclusion:The hygroxyethl starch applying to AHH can effectively maintain hemodynamic and homeostasis,prevent the excessive loss of blood cell and have no significant influence on coagulation funcˉtion.