急性超容性血液稀释对外科手术患者电解质及酸碱平衡的影响  

Effects of acute hypervolemic hemodilution on plasma electrolytes and acid-base equilibrium

作　　者：王蕊[1] 王江[1] 宣斐[1] 郑宏[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830011

出　　处：《新疆医科大学学报》2007年第11期1291-1293,共3页Journal of Xinjiang Medical University

摘　　要：目的:以急性超容性血液稀释(AHHD)为基础,观察AHHD对患者电解质及酸碱平衡的影响。方法:择期行耳鼻喉科或颌面外科手术患者14例,复合麻醉诱导及气管插管后,在30min内用林格式液10ml/kg补充生理需要量,以6%羟乙基淀粉溶液按双变量稀释法进行AHHD。于AHHD过程中每10分钟采动脉血1ml,用血气分析仪测定电解质、pH值、判断血液稀释的程度直至血液稀释完成,即时监测心率(HR)、平均动脉压(MAP)和中心静脉压(CVP)。结果:AHHD后患者Na+、Cl-、CVP升高(P<0.05),乳酸根(Lac-)、红细胞压积(Hct)、血红蛋白(Hb)、HCO3-、碱剩余(BE)降低(P<0.05),pH值略降低但差异无统计学意义(P>0.05)。结论:(1)以双变量稀释法进行AHHD是安全有效的,稀释后Hct可达到预定目标值;(2)AHHD可使电解质发生轻微改变但不会致酸碱平衡发生紊乱。合理选择与机体血液成分更相近的稀释液是保障AHHD过程中电解质及酸碱平衡稳定的前提。Objective： To investigate the effects of acute hypervolemic hemodilution （AHHD） on plasma electrolytes and acid-base equilibrium. Methods： Fourteen ASA Ⅰ - Ⅱ patients（6 male, 8 female） under- going elective orthopedic surgery were entered in this study. After induction of anesthesia the patients re- ceived 10 ml · kg^-1 Ringer＇s solution and 6G HES [predicted volume of infusion： predicted blood volume × （Hctbefore AHHD- Hctafter AHHD）/HctaftorAHHD] within 30min . Arterial blood samples were taken every 10 mi- nute for determination of the plasma electrolytes, acid-base equilibrium and the degree of hemodilution. And during the hemodilution the heart rate （HR）, mean arterial blood presure （MAP） and central vein pressure （CVP） were continuousely monitored. Results： After AHHD the plasma sodium concentration, chloride concentration and CVP increased （P≤40.05）, but the lactate concentration, bicarbonate concen- tration, Hct, Hb and BE decreased （P≤0.05）. The pH value drcreased slightly but without statistical meaning. The other values did not change during the hemodilution. Conclusions： （1） After AHHD, the Hct value can decreased to the predicted value （Hct=0.26）. AHHD with the formula [predicted volume of infusion= pre- dicted blood volume X （ Hctbdore AHHD- Hctafter AHHD）/HctafterAHHD] was effective and safe. （2） AHHD can change the plasma electrolytes slightly but can not induce the acid-base unequal. The colloid with more “physiologic” composition could be the key of keeping the balance of acid-based during the AHHD.

关 键 词：急性超容性血液稀释 电解质 酸碱平衡 

分 类 号：R614.1[医药卫生—麻醉学]