硬膜外麻醉复合全麻下术前高容量血液稀释对肝癌切除术患者失血耐受性的影响  

Effect of acute hypervolemic hemodilution on the patient' s tolerance to blood loss daring liver cancer resection under general anesthesia combined with epidural anesthesia

作　　者：冯艳平[1] 卢锡华[1] 章云飞[1] 王根生[1] 任柏林[1] 李廷坤[1] 

机构地区：[1]河南省肿瘤医院麻醉科,郑州市450003

出　　处：《中华麻醉学杂志》2006年第7期615-617,共3页Chinese Journal of Anesthesiology

基　　金：河南省科技攻关基金资助项目(0424410418)

摘　　要：目的探讨在全麻复合硬膜外麻醉下,6％羟乙基淀粉液(130／0．4,万汶)术前急性高容量血液稀释(AHH)对肝癌切除术患者失血耐受性的影响。方法ASAⅠ或Ⅱ级肝癌患者30例,随机分为试验组(V组)和对照组(C组),在硬膜外麻醉后,V组麻醉诱导前快速输注万汶15 ml·kg-1,C组输注乳酸钠林格液,方法同V组。监测平均动脉压(MAP)、心率(HR)和中心静脉压(CVP),并记录术中输血量、输液量及出血量;分别于稀释前、稀释后即刻、术毕和术后1 d测定红细胞压积(Hct)和血红蛋白(Hb)的变化。结果两组患者出血量和输液量相比差异无统计学意义(P>0．05),但V组输血量及输血率明显低于C组(P<0．05);V组MAP与HR维持较C组平稳;两组CVP在稀释后均明显升高,V组Hct和Hb在术毕和术后1 d明显低于基础值及C组,但均在正常范围。结论肝癌切除术患者在硬膜外麻醉复合全身麻醉下,术前采用万汶15 ml·kg-1行AHH,通过有效地维持血液动力学稳定,提高了患者对术中失血的耐受性。Objective To investigate the effect of acute hypervolemic hemodilution （AHH） with 6% hydroxyethyl starch （HES, 130/0.4, Voluven） on the patient＇s tolerance to blood loss during elective liver cancer resection performed under general anesthesia combined with epidural block. Methods Thirty ASA Ⅰ or Ⅱ patients aged 24-64 yrs weighing 42-71 kg undergoing elective liver cancer resection under general anesthesia combined with epidural block were randomized into 2 groups （ n = 15 each） ： AHH group and control group. Right internal jugular vein was cannulated for CVP monitoring. Epidural catheter was inserted through T7,8 interspace and advanced 3.5 cm into epidural space cephalad. Correct placement was identified by a test dose of 5 ml of 2% lidocaine. Voluven 15 ml·kg^-1 was then infused over 30 min in AHH group, while in control group lactated Ringer＇s solution 15 ml·kg^-1 was infused instead. Anesthesia was induced with midazolam, fentanyl, propofol and atracurium and maintained with propofol infusion and intermittent Ⅳ boluses of fentanyl and atracurium and epidural 1% lidocaine ＋ 0.375% levobupivacaine. MAP, HR and CVP were monitored during anesthesia. Hct and Hb were measured before and immediately after AHH, at the end of operation and at the 1st day after operation. Blood loss was measured by weighing the sponge after use （gravimetric method ） and recording the volume of blood in the suction bottle. Results The two groups were comparable with respect to demographic data, duration of operation blood loss and the amount of fluid infused during operation. The number of patients receiving blood transfusion and the volume of blood infused were significantly reduced in AHH group as compared with control group. MAP and HR were more stable during operation in AHH group than in control group. CVP was significantly increased after infusion of HES in AHH group and lactated Ringer＇s solution in control group. Hct and Hb were significantly lower at the end of operation and the 1st day after

关 键 词：羟乙基淀粉 肝肿瘤 血液稀释 麻醉 全身 麻醉 硬膜外 

分 类 号：R614[医药卫生—麻醉学]