血液稀释对全麻腹腔镜活体肾移植供体围手术期氧合功能的影响  

The effect of hemodilution on oxygenation function of living renal transplantation donor with general anesthesia

作　　者：崔华庆[1] 刘秀娟[1] 

机构地区：[1]胜利石油管理局胜利医院,山东东营257055

出　　处：《腹腔镜外科杂志》2008年第1期48-51,共4页Journal of Laparoscopic Surgery

摘　　要：目的：探讨不同血液稀释状态对全麻腹腔镜活体肾移植供体围手术期氧合功能的影响。方法：选择健康成年志愿捐肾者48例，随机分为4组：A组（n=10，对照组，乳酸钠林格氏液CIT）、B组（n=12，4～5ml／kg4％琥珀酰明胶HHD）、C组（n=13，20ml／kg4％琥珀酰明胶HHD），D组（n=13，30ml／kg4％琥珀酰明胶HHD）在全麻腹腔镜下行肾脏摘除术。B、C、D组于麻醉诱导后至肾动脉阻断前分别以4～5ml／kg、20ml／kg和30ml／kg4％的琥珀酰明胶静脉输注实施不同程度的血液稀释。术中监测麻醉诱导前（T0）、切皮后30min（T1）、肾动脉阻断时（T2）、肾动脉阻断后15min（T3）、手术结束时（T4）及手术结束后240min（T，）的平均动脉压（MAP）、心率（HR）、心电图（ECG）、脉搏血氧饱和度（SpO2）、中心静脉压（CVP）、心输出量（CO）、心脏指数（CI）等。于各时间点抽取动静脉血进行血气分析；T2、T4时分别记录胶体液、晶体液等。手术期间4组以20ml／kg·h^-1速率常规输注乳酸钠林格氏液。各组手术期间当MAP的变化超过基础值30％时可静脉输注硝酸甘油或多巴胺给予纠正，阻断肾动、静脉后常规应用速尿40mg。结果：（1）4组ECG、SpO2、晶体液总量等均无显著性差异（P〉0．05）；（2）C、D组T1、T2、T3、T4时MAP、CVP高于A、B组（P〈0．05），但均在正常范围内；（3）与T0时相比，C、D组T2、T3时Hb、HcT降低显著（P〈0．05），分别达中度（P〈0．05）和重度（P〈0．01）血液稀释水平；T2、T3时A、D组PaO2下降（P〈0．05），而C组升高（P〈0．05）。结论：不同血液稀释状态对全麻腹腔镜活体肾移植供体的氧合功能产生不同的影响，在心肺功能良好的供肾者中实施中等度高容量血液稀释是安全的。Objective：To explore the effect of the different hemodilution status on oxygenation function of living renal transplantation donor with general anesthesia. Methods ： Forty-eight healthy adult volunteers were divided into four groups ： A group （ n = 10, as control,sodium lactate Ringer＇s solution used） ,B group（ n=12,4-5ml/kg 4% Succinylated Gelatin used） ,C group（ n = 13,20ml/ kg 4% Succinylated Gelatin used）,and D group（ n = 13,30ml/kg 4% Succinylated Gelatin used） received laparoscopic renal transplantation under general anesthesia. B, C and D group were given 4% Succinylated Gelatin via injection venous respectively as the dosage of 4-5ml/kg,20ml/kg and 30ml/kg between induction of anesthesia and blockage of renal artery in order to perform different hemodilution. The index such as MAP, HR, ECG, SpO2, CVP, CO, CI were observed before induction of anesthesia （ TO ）, after making incision （T1 ）, blocking the renal artery （T2 ） and 15rain after blockage （T3） , the ending of operation （T4） and 240min after operation （ T5 ）. Blood gas analysis was also done at the same time and colloid and crystal liquid were respectively written down at T2 and T4. All groups were injected venously sodium lactate Ringer＇s solution at the speed of 20ml/kg· h^-1. When their values of MAP exceeded 30% of basis the patients would be given glycerol trinitrate and dihydroxyphenyl ethylamine. After the blockage of renal artery,40mg Furosemide were given. Results： （ 1 ） There are no significant difference in ECG, SpO2 and crystal liquid in four groups ; （2） MAP and CVP at T1 , T2, T3 and T4 in C and D group were higher than those in A and B group （P 〈 0.05 ）, but the values were in normal range;（3 ）Compared to those at To, Hb and Hct at T2 and T3 in C and D group decreased significantly （ P 〈 0.05 ）, which reach the level of moderate （P 〈 0.05 ） and severe hemodilution （P 〈 0.05）, PaO2 at T2 and T3 decreased in A and D group （P 〈 0.05 ） and that

关 键 词：麻醉 全身 血液稀释 氧合功能 活体肾移植 腹腔镜术 

分 类 号：R614.2[医药卫生—麻醉学]