急性等容血液稀释与利多卡因靶控输注对大鼠下腔静脉血栓形成的影响  

The effect of acute normovolemic hemodilution and intravenous target infusion of lidocaine on vena cava thrombosis in rat

作　　者：宋琳琳[1] 吴新民[1] 解大建[1] 

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《临床麻醉学杂志》2008年第2期157-160,共4页Journal of Clinical Anesthesiology

摘　　要：目的研究术前急性等容血液稀释（ANVH）和／或术中利多卡因靶控输注对大鼠下腔静脉结扎术后下腔静脉血栓形成的影响。方法300-400g雄性Wistar大鼠118只。3。析因设计，实验因素为术前ANVH[三个水平为不进行ANVH、生理盐水（NS）ANVH、羟乙基淀粉（HES）ANVH]和术中利多卡因输注（三个水平为血浆靶浓度0、4、10μg／ml）。各水平组合条件下行下腔静脉结扎。术毕心脏取血测定血栓弹性图（TEG）参数。术后第2天取出下腔静脉血栓，测长称重。结果术前NS—ANVH和HES—ANVH都使术毕TEG结果呈现高凝，前者更为显著。术中利多卡因输注结果相反。ANVH显著减轻术后血栓重量，HES—ANVH更为明显；利多卡因输注亦如此。HES—ANVH与利多卡因在减轻血栓重量上存在交互作用（协同）。结论术前ANVH，尤其HES—ANVH，显著减轻大鼠下腔静脉结扎术后静脉血栓形成。术中利多卡因输注作用相同。术前HES—ANVH与术中利多卡因输注存在协同交互作用。Objective To study the effect of preoperative acute normovolemic hemodilution （ANVH） and/or intraoperative plasma target infusion of lidocaine on vena cava thrombosis in a rat model of deep vein thrombosis. Methods Male Wistar rats weighted 300-400 g. Two factorial experiments were designed to explore the influence of preoperative ANVHEwithout ANVH, ANVH with normal saline（NS）, ANVH with hydrooxyethyl starch （HES）] and/or intraoperative target infusion of lidocaine （plasma levels of 0,4,10μg/ml） on TEG parameters and vein thrombosis after ligating vena cava in rats. On the 2nd day, the incidence of vena cava thrombosis among the groups were compared. Results Preoperative ANVH induced postoperative hypercoagulability as shown by TEG parameters,especially with NS-ANVH. Target infusion of lidocaine during operation decreased postoperative α and MA concentration-dependently. It was found that thrombus weights were reduced in an order of no-ANVH 〈 NS-ANVH 〈 HES-ANVH. Significantly reduced thrombus weights occurred with a higher concentration of lidocaine. The interaction exerted in a synergistic way between HES-ANVH and target infusion of lidocaine on thrombus weight. Conclusion Postoperative vena cava thrombosis was markedly less with the treatment of preoperative ANVH, especially with HES- ANVH in the rat model of deep vein thrombosis. Intraoperative lidocaine infusion behaved in the same manner. There was a synergistic interaction between HES-ANVH and lidocaine indicated by significaficantly reduced vena cava thrombosis.

关 键 词：静脉血栓形成 大鼠 血栓弹力描记术 血液凝固 

分 类 号：R614[医药卫生—麻醉学]