急性高容量血液稀释在全麻中应用的可行性  

Possibility of Application of Acute Hypervolemic Hemodilution in General Anesthesia

作　　者：曹建国[1] 黄贞玲[1] 刘万枫[1] 王珊娟[1] 杭燕南[1] 

机构地区：[1]上海第二医科大学仁济医院麻醉科,上海200001

出　　处：《上海第二医科大学学报》2005年第1期70-73,共4页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的观察丙泊酚诱导和吸入0.5MAC异氟醚(ISO)后输注琥珀酰明胶或6%经乙基淀粉200/0.5(HES)15mL/kg行急性高容量血液稀释(AHH)时血流动力学及渗透压的变化,探讨全麻下行AHH的可行性。方法胃肠肿瘤手术患者30例,分为两组,组Ⅰ为明胶组(n=15)、组Ⅱ为HES组(n=15)。丙泊酚全麻诱导后气管插管,经口插入食管超声多普勒探头,实施AHH,吸入0.5MACISO,30min内从肘静脉输入明胶或HES15mL/kg。监测心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、每搏指数(SI)、心指数(CI)、外周血管阻力(SVR)、左室射血时间(LVETi)、射血加速度(Acc);抽血测红血球压积(Hct)和晶体、胶体渗透压。结果两组稀释完毕时和30min后,SI、CI显著升高(P(0.01)。两组稀释后各时刻点,SVR均明显下降(P<0.05);稀释20min、稀释完毕时和30min后,CVP显著上升(P<0.01)。MAP在稀释完毕时,组Ⅱ高于组Ⅰ(P<0.05)。HR、Acc、LVETi均无差异(P>0.05)。Hct在两组均显著降低(P<0.05)。晶渗压与胶渗压组内、组间无显著差异(P>0.05)。结论丙泊酚全麻诱导和吸入0.5MACISO后输注明胶或HES实施AHH,均使SI、CI、CVP上升,SVR下降,对心肌收缩力无明显影响,渗透压保持平稳,扩容效果满意,可安全应用于临床。Objective To assess the changes of hemodynamics and osmotic pressure under acute hypervolemic he-modilution ( AHH) during infusion with gelatine or 6% hydroxyethyl starch (HES) after induction of propofol and inhalation with 0.5 MAC isoflurane, and evaluate the possibility of applying AHH in general anesthesia. Methods Thirty patients undergoing gastric and intestinal tumor operations, were randomly divided into two groups: group I, gelatine ( n = 15) , and group Ⅱ, HES (n = 15). After induction by propofol and tracheal intubation, the transesopha-geal Doppler echo sound probe was inserted into the esophagus of patients, and then AHH was carried out. The patients were inhaled with 0.5 MAC isoflurane, gelatine or HES 15 mL/kg was infused through the cubital vein within 30 min. HR, MAP, CVP, SI, CI, SVR, LVETi and Acc were monitored, and blood samples were taken to measure Hct, crystalloid and colloid pressures. Results SI and CI were increased significantly in both groups at the end and at 30 min after the end of hemodilution (P <0.01 ) . SVR was decreased significantly in two groups at all time-points after hemodilution (P <0.05). CVP was increased significantly at 20 min, the end and 30 min after the end of hemodilution (P<0.01), and MAP was increased more in group Ⅱ than in group I (P<0. 05), while HR, Acc and LVETi had no change (P>0.05). Hct was decreased significantly in both groups (P<0.05). Crystalloid and colloidal osmotic pressures had no changes within or between groups. Conclusion Though SI, CI and CVP increase and SVR decreases, it has no influence on mycardial contraction or osmotic pressure during infusion with gela- tine or 6% HES under AHH after induction of propofol and inhalation with 0. 5 MAC isoflurane. This suggests that acute hypervolemic hemodilution is safe to be utilized in general anesthesia.

关 键 词：急性高容量血液稀释 胶体溶液 血流动力学 渗透压 丙泊酚 异氟醚 麻醉 

分 类 号：R614.21[医药卫生—麻醉学]