高容血液稀释对老年冠心病患者术中循环功能的影响  

Effect of hypervolemic hemodilution on circulatory function of elderly patients with coronary heart desease during operation

作　　者：李文广[1] 毕素萍[1] 米卫东[1] 

机构地区：[1]解放军总医院麻醉科,北京100853

出　　处：《军医进修学院学报》2004年第6期432-433,共2页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的 :观察高容血液稀释对老年冠心病患者术中循环功能的影响 ,为冠心病患者围术期合理输液提供依据。方法 :80例冠心病患者行非心脏手术。平均年龄 72 .8岁 ,体重 6 7.5kg。入室后第 1h输注 6 %HES和平衡液各 2 0ml·kg 1。观察输液前、后和术毕Hct、CVP、MAP、HR、ECGST T、SpO2 和尿量变化。结果 :输液前Hct 0 .4 2、CVP 0 .33kPa、MAP 14 .9kPa、HR 97/min、ECGST T均为缺血改变、SpO2 96 %～ 98%、前 5 0min无尿。液体 4 0ml·kg 1输入后Hct0 .31、CVP 1.0 8kPa、MAP 11.3kPa、HR 83、ECGST T均有改善、SpO2 98%～ 10 0 %、尿量 6 8ml。属于轻度血液稀释 ,循环处于理想状态。之后 2 .2 5h液体维持量平均 2 2 94ml(15ml·kg 1·h 1)。整个手术过程循环平稳。术毕平均尿量 6 5 0ml。术后 79例痊愈出院 ,1例死于心肌梗死。结论 :老年冠心病患者入室后第 1h输液 4 0ml·kg 1,有利于术中循环稳定 ,有利于改善微循环和心功能 。Objective:To observe the effect of hypervolemic hemodilution on circulatory function of elderly patients with coronary heart disease during operation . Methods:80 patients (with average age of 72.8 years old and body weight of 67.5 kg) undergoing non-heart operation received hemodilution which was accomplished by infusion of Ringer's solution and 6% hydroxyethyl starch at the rate of 20 ml·kg -1·h -1 respectivly during the first hour of the operation. Hct, CVP, MAP, HR, ECG ST-T, SpO 2 and urine output were all measured at endpoints of preinfusion, 10 min after postinfusion and postoperation. Results:The mean Hct was decreased to 0.31 from 0.42 of preinfusion after postinfusion. CVP was increased to 1.17 kPa from 0.33 kPa. MAP and HR lowered from 14.9 kPa and 97bpm to11.3 kPa and 83bpm. Ischemic sign of ECGST-T was also improved after solution infusion. This mild hemodilution could keep circulation in ideal state all through the operation.There was no urine with-in the first 50 mins but urine output was 68ml following 50 min of infusion and 650ml at the end of the operation. 79 cases were cured and discharged from hospital. One case died of myocardial infarction.Conclusion:Infusion at the rate of 40 ml·kg -1·h -1during the first hour of the operation not ohly helps to stabilize circulation, to improve microcirculation and heart function but also diminishes complications.

关 键 词：高容血液稀释 老年 冠心病 循环功能 微循环 术中 

分 类 号：R654.2[医药卫生—外科学]