6%羟乙基淀粉预扩容对全髋置换术病人术中胃粘膜pH的影响  

Effect of volume expansion with 6% hydroxyethyl starch on gastric intramucosal pH in patients undergoing total hip replacement

作　　者：张伟[1] 杨拔贤[2] 姚长智[1] 刘雪冰[1] 孙晓雄[1] 

机构地区：[1]北京积水潭医院麻醉科,100035 [2]北京大学人民医院麻醉科

出　　处：《临床麻醉学杂志》2005年第1期29-32,共4页Journal of Clinical Anesthesiology

摘　　要：目的　观察中分子量羟乙基淀粉(6%HES)预扩容对复合麻醉下全髋置换病人胃粘膜 pH(i pH)和胃粘膜二氧化碳分压(PgCO2)以及PgCO2与动脉二氧化碳分压(PaCO2)的差值 (PCO2gap)的影响。方法　择期拟行全髋关节置换的患者28例,随机分为羟乙基淀粉组(H组)和 复方氯化钠组(R组)。均在硬膜外阻滞复合全麻下手术。分别于诱导后切皮前以6%HES(H组)15 ml/kg或复方氯化钠(R组)15ml/kg扩容,术中两组均恒速输入6%HES3ml/kg和复方氯化钠6 ml/kg。分别于扩容前(T0)、扩容后切皮前(T1)、切皮后30min(T2)、60min(T3)及手术结束时(T4) 记录动脉pH(pHa)、PaCO2、动脉血乳酸(Lac)、i pH、PgCO2和PCO2gap。术中同时记录平均动脉压 (MAP)、心率(HR)、中心静脉压(CVP)、出血量、血红蛋白(Hb)、红细胞压积(Hct)和尿量。结果 i pH在T3及T4时H组均明显高于R组(P<0.05)。PCO2gap在T3及T4时,H组均明显低于R 组(P<0.05)。T4两组Hct、Hb、pHa及Lac无显著性差异。结论　6%HES预扩容对于维持复合 麻醉下全髋置换病人术中胃粘膜的灌注优于复方氯化钠。Objective To investigate the effect of volume expansion with hydroxyethyl starch(6%HES,200/0.5) on gastric intramucosal pH(i-pH) and the difference between PgCO 2 and PaCO 2(PCO 2gap).Methods Twenty-eight ASAⅠ-Ⅱ patients, aged between 55-70y ,without any chronic or acute stomach diseases, undergoing total hip replacement were divided randomly into hydroxyethyl starch group(group H) and Ringer's group(group R). All patients received combined epidural- general anesthesia. Patients received 6%HES 15ml/kg in group H or Ringer's 15ml/kg in group R before skin incision and received 6%HES 3ml/kg and Ringer's 6ml/kg during operation. Anesthesia was maintained with isoflurane inhalation and intermittent iv boluses of vecuronium. Data of arterial pH(pHa), arterial CO 2 (PaCO 2),arterial lactate acid concentration(Lac),i-pH,PgCO 2 ,PCO 2gap were recorded before volume expansion(T 0),after volume expansion(T 1) and at 30 min(T 2),60 min(T 3) after skin incision and at the end of surgery(T 4). MAP,HR,CVP,blood loss,Hb,Hct,urinary output were monitored and recorded at the same time points. Results At T 3 and T 4,the i-pH in group H was significantly greater than those in group R(P<0.05). PCO 2gap in group H at T 3 and T 4 was significantly lower than that in group R (P<0.05).There was no significant difference between the two groups at the end of the surgery(T 4)in terms of Hb、Hct ,Lac and pHa. Conclusion In patients undergoing total hip replacement under combined epidural-general anesthesia, volume expansion with hydroxyethyl starch(6%HES,200/0.5) before skin incision may improve splanchinc blood flow and tissue oxygenation.

关 键 词：羟乙基淀粉 预扩容 全髋置换术 术中 胃粘膜PH 复合麻醉 

分 类 号：R614[医药卫生—麻醉学]