预扩容对血流动力学及血液流变学的影响

Clinical observation of the effect of pre-anesthetic hypervolemic hemodilution on hemodynamic and homorheology property

目的 :观察麻醉前输入6%羟乙基淀粉对病人血流动力学及血液流变学的影响。方法 :40例行择期妇科手术的病人随机分为羟乙基淀粉组(H组)和复方乳酸钠组(L组),每组20例。麻醉前按15ml/(kg·h)的速度分别输入6%羟乙基淀粉注射液(H组)和复方乳酸钠注射液(L组)。术中监测MAP、HR、CVP、SpO2,分别于稀释前后测定全血粘度、红细胞比容、血浆粘度、红细胞聚集指数、红细胞变形指数。结果 :L组术中MAP和HR的下降明显大于H组 (P<0.05),H组的血流动力学稳定。H组的CVP稀释后明显升高(P<0.01) ,但在正常范围内。预扩容后各组全血粘度均明显降低 (P<0.05)。H组Hct明显降低 (P<0.01)。H组血浆粘度无变化(P>0.05) ,L组显著降低 ,且显著低于H组 (P<0.05)。预扩容后两组红细胞聚集指数降低 ,H组明显低于L组(P<0.05) ,H组红细胞变形指数明显升高 (P<0.01)。结论 :预扩容技术能安全有效地使围术期病人保持循环稳定 ,优化血液流变状态 ,利于微循环灌注 ,提高病人对失血的耐受性 。

Objective: To evaluate the hemodynamic effect and the changes of hemorheology property in patients undergoing pre-anesthetic hypervolemic hemodilution with 6%hydroxyethyl starch. Methods: Forty patients undergoing gynecologic surgery were randomly allocated into two groups: Group hydroxyethyl Starch (group H) and Group Lactated Ringer's Solution (group L). Each group involving 20 patients. The patients were infused 6%hydroxyethyl starch(group H) or Lactated Ringer's solution(group H) at a rate of 15mlkg-1h-1. Interoperative observed parameters include: MAP、HR、CVP、SpO2. Blood samples were collected before and after hemodilution for measuring the changes of the viscosity of whole blood、HCT、plasma viscosity、the index of RBC aggregation and the index of RBC deformation. Results: In the group L there was a significant decrease in MAP and HR after hemodilution comparing group H(P<0.05). There is a significant increase in CVP in group H after hemodilution(P<0.01)but still in a normal range. A decrease in the index of RBC aggregation was observed in two groups after hemodilution,group H got a significant decrease comparing group L (P<0.01). Hct significantly decreased after dilution in group H (P<0.01). There is no defference in plasma viscosity in group H(P>0.05)but a significant decrease in group L comparing before dilution and group H(P<0.05).The index of RBC deformation significantly increased in group H(P<0.01). Conclusion: Pre-anesthetic hypervolemic hemodiluion effectively maintain the stability of circulationand have a benificial effect on the tissue infusion. It can safely improve the duration suffering blood loss and reduce the requirement of homologous blood transfusion. This study shows that pre-anesthetic hypervolemic hemodiluion is applicable for clinical usage.