全麻诱导期急性高容量血液稀释用于老年手术患者的可行性  

Feasibility of acute hypervolemic hemodilution in the elderly patients during the induction of general anesthesia

作　　者：滕如阳[1] 艾艳秋[1] 张卫[1] 李莉[1] 

机构地区：[1]郑州大学第一附属医院麻醉科

出　　处：《郑州大学学报（医学版）》2006年第4期749-751,共3页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:探讨急性高容量血液稀释(acutehypervolemichemodilution,AHH)在老年患者全麻诱导期应用的有效性和可行性。方法:选择20例腹部择期手术老年患者,年龄65～76岁,ASAⅠ～Ⅱ级,无心肺疾患,无高血压病史。随机分为2组:血液稀释组(A组,n=10)和对照组(B组,n=10),均采用气管内全麻。2组患者入室后常规输液,采用421法则补充基础生理需要量,按0.7～0.8ml/(kg·h)补充禁食量。A组患者在此基础上,按25ml/min的速率输入60g/L羟乙基淀粉(HES)7ml/kg后开始诱导,同时继续输入60g/LHES达15ml/kg。监测心电图、平均动脉压(pMA)、心率(fH)、中心静脉压(pCV)、血氧饱和度、红细胞压积、乳酸和动脉血气的变化。结果:A组全麻诱导后pMA下降不明显,pCV升高,但在正常范围内,与基础值及同时相B组相比差异有统计学意义(P<0.05);B组患者诱导后pMA明显低于基础值(P<0.01);2组的fH、乳酸和动脉血气在AHH前后无明显变化(P>0.05),组间比较差异无统计学意义(P>0.05)。结论:全麻诱导期AHH应用于无心肺疾患的老年患者安全可行,可预防诱导期低血压的发生,有利于保持血液动力学平稳。Aim： To evaluate the feasibility and effectiveness of acute hypervolemic hemodilution （AHH） with 6% hydroxyethyl starch（HES） in the elderly patients during induction of general anesthesia. Methods： Twenty ASA Ⅰ - Ⅱ patients without cardiac or pulmonary disease undergoing elective abdominal operation were randomly allocated into two groups： AHH group （group A,n = 10） and control group （group B,n = 10）. Both groups accepted general anesthesia. In addition, patients of group A received 6% HES at 15 ml/kg. ECG, PMA ,x（ O2 ） , fH and PCV were continuously monitored. Arterial blood samples were taken for blood gas analysis and determination of lactic acid, Hct and Hb before and after AHH. Results： There was no significant change in blood lactic acid, fH and PaCO2 in both groups after AHH. After induction, pMA decreased signicantly（ P 〈 0.01 ） in group B, however, PMA decreased and PCV increased but still maintained normal in group A（P 〉0.05 ）. Conclusion： AHH with 6% HES at 15 ml/kg can be well tolerated by the elderly patients without cardiac or pulmonary disease and can maintain stable hemodynamics during induction of general anesthesia.

关 键 词：诱导期 急性高容量血液稀释 老年人 可行性研究 

分 类 号：R614.1[医药卫生—麻醉学]