老年患者行急性高容量血液稀释时食管超声多普勒监测血液动力学变化  

Transesophageal echo-doppler monitoring of hemodynamic changes during acute hypervolemic hemodilution in elderly patients

作　　者：陈绍洋[1] 胡胜[1] 董海龙[1] 王强[1] 张怡[1] 杨丽芳[1] 李杨[1] 熊利泽[1] 

机构地区：[1]第四军医大学西京医院麻醉科,西安市710032

出　　处：《中华老年医学杂志》2005年第2期89-92,共4页Chinese Journal of Geriatrics

基　　金：第四军医大学金桥工程基金资助项目 (NO 0 10 15 )

摘　　要：目的　观察老年患者行急性高容量血液稀释 (AHHD)时血液动力学和氧供变化。　方法　选择择期开腹手术全麻患者 34例 ,按年龄分为老年组 (≥ 6 5岁 )和对照组 (<6 5岁 ) ,每组 17例。静脉诱导气管插管后控制呼吸 ,吸入 0 6MAC异氟醚维持麻醉 ,按 5ml/kg 30min内静脉输入 6 %羟乙基淀粉行AHHD。应用HemosonicTM10 0食道超声多普勒血液动力学监测仪连续监测每搏量、心输出量、心脏指数和动脉内血流量、血流峰速度、血流加速度、左室射血时间、全身外周血管阻力等 ,记录稀释前 (T0 )、扩容 15min(T1)、30min(T2 )和稀释结束后 10min(T3 )各项监测数据 ,并检测各时间点动脉血气 ,计算氧供。　结果　与T0 相比 ,两组T1、T2 和T3 的每搏量、心输出量和动脉内血流量均明显增加 (P <0 0 5 ) ,T2 血流峰速度明显增快 (P <0 0 5 ) ,T1、T2 和T3 的外周血管阻力明显降低 (P <0 0 5 ) ;两组T2 和T3 的血红蛋白、红细胞压积和动脉血氧含量明显降低 (P <0 0 5 ) ,但T1、T2 和T3 的氧供均明显增加 (P <0 0 5 )。而左室射血分数仅老年组T2 较T0 明显延长 (P <0 0 5 )。　结论　老年患者行AHHD可维持血液动力学稳定 ,保证充分氧供 ,但应谨慎对待其对心脏收缩功能的潜在影响。Objective To observe the changes in hemodynamics and oxygen delivery(DO 2 ) by transesophageal echo doppler during preoperative acute hypervolemic hemodilution(AHHD) with 6% hydroxyethel starch(HES) in elderly patients. Methods Thirty four patients, undergoing elective laparotomy were randomly divided into elderly group(age≥65 years) and control group(age<65 years). The anesthetic management was standardized for all patients. After induction of anesthesia and tracheal intubation, the Hemosonic TM 100 transesophageal echo doppler probe was placed in the esophagus at the level of T 5 6 vertebra for monitoring cardiac output (CO), stroke volume(SV), cardiac index(CI), peak acceleration(Acc), peak velocity(PV) and left ventricular ejection time index(LVET). Mean arterial blood pressure(MAP) were entered into the monitor every 5 min to derive total systemic vascular resistance(TSVR) values. Anesthesia was maintained with inhaling 0 6 MAC isoflurane. Patients were infused 15 ml/ kg HES within 30 min. These parameters were recorded and blood sample was drawn for blood gases measurement before hemodilution(T 0 ), and 15 min, 30 min after infusion of HES(T 1 , T 2 ), and 10 min after end of AHHD(T 3 ). DO 2 was calculated. Results Compared with corresponding parameters at T 0 , SV, CO, CI and ABF significantly increased( P <0.05) and TSVR markedly decreased( P <0.05) at T 1 , T 2 and T 3 , and PV at T 2 significantly rose ( P <0.05) in two groups. Hemoglobin, hematocrit and CaO 2 at T 2 and T 3 markedly reduced( P <0 05) while DO 2 at T 1 , T 2 and T 3 significantly increased( P <0.05)in two groups compared with those at T 0 . LVET at T 2 in elderly patients markedly prolonged( P <0.05) compared with that at T 0 . Conclusions AHHD in elderly patients can maintain stable hemodynamics and ensure sufficient oxygen delivery. However it should be cautious of potential effect of AHHD on cardiac systo

关 键 词：血液动力学 氧供 老年患者 急性高容量血液稀释 血流 超声多普勒 动脉内 每搏量 结论 速度 

分 类 号：R445.1[医药卫生—影像医学与核医学]