羟乙基淀粉130/0.4急性高容量血液稀释对骨科手术患者内环境的影响  

Effects of acute hypervolemic hemodilution with hydroxyethyl starch 130/0.4 on plasma homeostasis in patients undergoing orthopedics surgery

作　　者：鲁卫华[1] 金孝岠[1] 朱美芳[1] 曹亚[1] 姚卫东[1] 

机构地区：[1]皖南医学院附属弋矶山医院麻醉科,安徽省芜湖市241001

出　　处：《临床麻醉学杂志》2008年第5期379-381,共3页Journal of Clinical Anesthesiology

基　　金：安徽省教育委员会自然科学研究项目(2003kj315)

摘　　要：目的探讨硬膜外复合全身麻醉下6%羟乙基淀粉130/0.4急性高容量血液稀释对骨科手术患者内环境的影响。方法选择ASAⅠ或Ⅱ级择期骨科手术患者28例,随机均分为急性高容量血液稀释组(AHH组)和对照组(C组)。均采用硬膜外阻滞复合全身麻醉。AHH组硬膜外阻滞起效后开始血液稀释,快速输入6%羟乙基淀粉130/0.420ml/kg,速率50ml/min;C组常规输液。术中连续监测MAP、HR、SpO2、CVP、ECG和PETCO2。分别于稀释前即刻(T0)、稀释后5min(T1)、120min(T2)采取桡动脉血进行电解质、乳酸(Lac)、血糖(BG)、尿素氮(BUN)、Hct及Hb测定,计算血浆渗透浓度(Posm)。结果AHH组Hct及Hb血液稀释后下降约20%。与C组相比,AHH组患者的MAP、HR较平稳,术中输液量、尿量增多。与T0相比,AHH组T1时CVP升高,T2时pH值降低(P<0.05)。两组患者的BG在T2时增高,且C组高于AHH组(P<0.05)。两组各时点血电解质、Lac、BUN、HCO3-、BE、Posm等各指标差异均无统计学意义。结论硬膜外复合全身麻醉下6%羟乙基淀粉130/0.4急性高容量血液稀释能维持内环境的相对稳定。Objective To investigate the effects of acute hypervolemic hemodilution（AHH） with hydroxyethyl starch （HES） 130/0.4 on plasma homeostasis in patients undergoing orthopedics surgery performed under general anesthesia combined with continuons epidural block. Methods Twenty-eight ASA class Ⅰ or Ⅱ patients were randomized to AHH group and control group （C group） with 14 cases each. Lactated Ringer＇s solution was infused at 6-8 ml/kg before anesthesia. AHH group was given 6% HES 130/0, 4 20 ml/kg infused at a dose of 50 ml/min. C group was transfused Lactated Ringer＇s solution. At the same time anesthesia was induced. BP, CVP, ECG, SpO2 and PETCO2 were continuously monitored before and during anesthesia. Arterial blood samples were taken before AHH （T0） ,at 5 min （T1） and 120 min （T2） after AHH for blood gas analysis and determination of Hb, electrolytes, glucose, lactate and blood urea nitrogen （BUN） concentration. Plasma osmotic concentration was calculated. Results At the end of AHH,Hct and Hb decreased by 20% as compared With the baseline values in group AHH. To compared with group C,MAP and HR of AHH group were stable with more fluid infusion and urinary production during operation. CVP was significantly higher at T1 and pH lower at T2 than at To in group AHH. Blood glucose level of both groups at T2 was significantly higher than that at To （P〈0.05）. There were no significant differences in plasma K^＋ , Na^＋ ,Ca^2＋ , Cl^- , Lac, BUN, HCO3^- , BE and plasma osmotic concentration at T0-T2 between the two groups. Conclusion AHH with HES130/0.4 can maintain homeostasis in patients undergoing orthopedics surgery under general anesthesia combined with continuons epidural block.

关 键 词：羟乙基淀粉 血液稀释 内环境稳态 

分 类 号：R614[医药卫生—麻醉学]