全身麻醉下急性高容量血液稀释对手术病人脑代谢的影响  

Effect of Acute Hypervolemic Hemodilution on Cerebral O2 Supply/Consumption and Energy Metabolism during General Anesthesia

作　　者：赵树恩[1] 武广义[1] 郭晓俊[1] 

机构地区：[1]保定市河北大学附属医院麻醉科,保定071000

出　　处：《麻醉与监护论坛》2007年第3期151-152,共2页Forum of Anesthesia and Monitoring

摘　　要：目的：探讨全身麻醉下急性高容量血液稀释对手术人脑代谢的影响。 方法：选择ASAⅠ或Ⅱ及择期手术病人16例，采取静吸复合麻醉，气管插管后，行桡动脉穿刺置管监测血压，右侧颈内静脉逆向穿刺，行右颈内静脉球部置管，并进行高容量血液稀释，快速输注6%羟乙基淀粉15ml/kg,输液速率为50ml/min.分别于稀释前即刻（T0），稀释后15min（T1）,90min（T2）、采取桡动脉和颈内静脉球血、分别进行血气分析、乳酸、血糖、红细胞比容 （Hct）及血红蛋白（Hb）测定，并计算动脉-颈内静脉血乳酸浓度差（VADL）、动脉-颈内静脉血氧含量差[D（a-v）O2]／脑氧摄取率（CERO2）和脑葡萄糖摄取率（CMRGIu）. 结果：与T0比较，T1时SvO2上升、D（a-v）O2、CERO2、下降、T2时D（a-v）O2下降（P＜0.05）,T1、T2时Hb降低（P＜0.05）,其余各指标无统计学意义。 结论：全身麻醉下急性高容量血液稀释可增加脑氧供应，维持脑氧和能量代谢的稳定。Objective： To investigate the effect of acute hypervolemic hemodilution（AHH）on cerebral O2 supply/consumption and energy metabolism in patients undergoing elective surgery under general anesthesia. Methods： Sixteen ASA I or II patients （9 male,7 female） aged 45-63 yrs weighing 62-73kg undergoing elective surgery under general anesthesia were enrolled in this study. After induction of general anesthesia was confirmed radial artery was cannulated for BP monitoring and blood sampling. Right internal jugular vein was retrogradely cannulated and advanced cephalad until jugular bulb for blood sampling. AHH was conducted by infusing 6% HES 15ml/kg at 50ml/min after induction of general anesthesia. Blood samples were taken from artery and jugular venous bulb simultaneously for blood gas analysis, determination of Hb and Hct, glucose and lactate concentrations before AHH （T0）, at 15 min（T1） and 90 min（T2） after AHH was accomplished. Arterial-jugular bulb venous lactate difference（VADL）, arterial-jugular bulb venous O2 content difference（Da-vO2） ,cerebral 02 extraction rate（CERO2）, and glucose extraction rate（CMRglu） were calculated. Results： At the end of AHH Hb and Hct decreased as compared to the baseline values before AHH. SvO2 was significantly higher, Da-vO2 smaller and CERO2 lower at T1 than at T0.There were no significant differences in BP, HR, CMRglu and VADL at all time points. Conclusion： AHH can increase cerebral O2 supply and has no significant effect on cerebral glucose metabolism during operation performed under general anesthesia.

关 键 词：血液稀释 脑耗氧 葡萄糖 麻醉 全身 

分 类 号：R457.1[医药卫生—治疗学]