术前高容量血液稀释对酸碱平衡和电解质影响  

The Effect of Preoperative Acute Hypervolemic Hemodilution on Acid-base Equilibrium and Electrolyte in Patients Undergoing Epigastric Surgery

作　　者：程静林[1] 王春亭[1] 

机构地区：[1]郑州大学二附院麻醉科,郑州450014

出　　处：《中国现代医生》2007年第05X期17-19,共3页China Modern Doctor

摘　　要：目的观察比较用万汶和乳酸钠林格氏液行轻度AHH对上腹部手术病人酸碱平衡和电解质的影响。方法选择上腹部择期手术病人30例,随机分为A组(万汶组)和B组(对照组),每组15人,A组、B组分别用万汶和LR经颈内静脉行术前AHH,输注量为15mL/kg,以25～35mL/min左右的速度输注。两组病人均采用全麻复合硬膜外麻醉,硬膜外穿刺点选T7～9。所有病人均于AHH前(T1)、AHH后(T_2)、AHH后30min(T_3)、AHH后60min(T_4)、AHH后3h(T_5)分别采集桡动脉血2mL立即行动脉血血气分析、HCT、Hb及电解质检测。结果(1)A组病人AHH过程中及术中MAP、CVP相对保持平稳,但B组于T_3、T_4MAP、CVP均低于基础值(P<0.05);两组HR变化无统计学意义(P>0.05)。(2)T_2后A组PH、HCO3-及BE均降低,血Cl-升高,血K+降低;B组在T_2后除有轻度的低钠血症外,血Cl^-、血K^+、PH、HCO_3^-及BE无明显变化。结论用万汶行术前轻度AHH:(1)扩充血容量效果好,优于晶体液,血流动力学较稳定。(2)可能发生高氯性酸中毒和低钾血症,要注意液体的合理配伍。Objective To compare the effect of preoperative acute hypervolemic hemodilution on acid-base equilibrium and electrolyte with hydroxyethyl starch （130/0.4 Voluven） and Lactated Ringer＇s （LR）. Methods 30 patients with no heart disease, scheduled for upper abdominal surgery, aged from 29 to 63yr, weighted from 52 to 80kg, ASA Ⅰ - Ⅱ, HCT≥33%, Hh〉110g/L, were all received Combined epidural-general anesthesia. At first, all patients were received epidural anesthesia performance （T7-9） before AHH. Then, the patients were randomly assigned to receive either Voluven （group A： n = 15） and LR （group B n=15 as a control） at dose of 15mL/kg and rate of 25 - 35mL/min via internal jugular vein. The anesthesia induction and drug of anesthesia maintenance is all the same. HR,ECG,MAP,CVP and SPO2 were monitored continually during operation. Arterial blood sample were obtained at before AHH（T1 ）, after AHH（T2）, 30min after AHH（T3）, 60rain after AHH（T4）, 3h after AHH（T5） for the following：（1）Blood gas analysis including HCT and Hb;（2）Concentrations of serum Na^＋,K^＋and Cl^-. Results （1）Compare between two groups on MAP and CVP： At T3,T4 the MAP and CVP of group B were significantly lower than that of group A （P〈0.05） and group A maintain relative stable. Compare between two groups on HR： There were no significant differences （P〉0.05）.（2）At T2, PH,HCO^-3 and BE decreased significantly（P〈0.05）, serum Cl^- rised and K^＋ decreased significantly（P〈0.05） in group A; But PH,HCO^-3,BE,Na^＋,K^＋and Cl^- were no significant changed（P〉0.05） in group B. Conclusion （1）This study confmned that the new generation of artificial colloid Voluven could effectively maintain hemedynamic stable. Its volume expansion effect and maintaining time is better then LR. （2）The infusion of a great quantity of Voluven may cause hyperehlorine acidosis, because it contained 154mmol.L/L of Cl^-. Rational match of solutions need study continuously.

关 键 词：6%羟乙基淀粉液 急性高容量血液稀释 腹部手术 血液动力学 酸碱平衡 电解质 

分 类 号：R973.5[医药卫生—药品]