高容血液稀释对血常规和血流动力学的影响

The influence of profound hemodilution on blood elements and hemodynamics

目的:观察高容血液稀释对部分血常规和血流动力学的影响,为术中合理输液提供依据。方法:择期手术20例,人室后第1 h输注1:1平衡盐液和6％Hes 40 ml·kg～1。输液前、输液后10 min和术毕分别取中心静脉血检验。检测指标:Hct、Plt、RBCG、MCHC、Osm、CVP、MAP、HR、SpO2、尿量变化。结果:输液后10 min,血常规降低,Hct 0.27、Plt 0.24、RBCG 0.002 5 cell/L、MCHC 5.75 g/L(P<0.05)。CVP由0.27 kPa升至1.23 kPa(P<0105)。Osm无明显变化(P>0.05)。MAP、HR、SpO2稳定在正常范围。尿量35 ml。术毕尿量510 ml,其余指标维持在输液后10 min的水平。结论:患者入室后第1 h输1:1晶、胶液40 ml·kg-1,可纠正脱水、补足血容量,有利于术中循环稳定,减少失血和并发症,有利于患者康复。

Objective:To observe the effect of profound hemodilution on prat of blood elements and hemodynamics and to supply theory base for clinical proper infusion. Methods;20 patients undergoing elective operation received hemodilution which was accomplished by infusion of Ringer Ⅱ and 6% hydroxyethyl starch at the rate of 20 ml · kg-1 · h-1 respectively during the first hour of the operation. Then infusion rate was adjusted according to bleeding and urine output. Hemanalysis, Serum osmolarity, CVP,MAP,HR,Sp02 and urine output are all measured at different time of preinfusion,ten minutes after postinfusion and postop-eration. Results:Hct. lowered by 0. 27 10min after postinfusion. Plt . RBCG and MCHC decreased by 0. 24 percent ,0. 0025 cell/L and 5. 75g/L respectively( P < 0. 05 ) . CVP returned to 1. 23 kPa from origional 0. 27 kPa( P < 0. 05 ) . Serum osmolarity had no significant change ( P>0. 05 ). MAP. HR and Sp02 were stable. Urineoutput was 35 ml. 10min after postinfusion and 510ml after postoperation. All measured data of postoperation exept Urineoutput were the same as those of lOmin after postinfusion. Conclusions: infusion at the rate of 40 ml · kg -1· h-1 during the first hour of the operation belongs to mild-medius hemodilution which helps to sustain smooth circulation and diminish blood loss and complications.