急性高容量血液稀释对老年病人循环功能及心肌肌钙蛋白的影响  

Effect of Acute Hypervolemic Hemodilution on Circulate Function and Cardiac Troponin I in Elderly Patients under Epidural Anesthesia

作　　者：林子波[1] 纪浩聪[1] 高晓枫[1] 

机构地区：[1]惠州市中心人民医院麻醉科,广东惠州516001

出　　处：《河南职工医学院学报》2008年第5期426-429,共4页Journal of Henan Medical College For Staff and Workers

摘　　要：目的观察急性高容量血液稀释（AHH）对硬膜外麻醉下老年病人循环功能及心肌肌钙蛋白Ⅰ（CTnⅠ）的影响，探讨AHH在老年患者术中应用的安全性。方法选择ASAⅠ～Ⅱ级，无心肺疾患的硬膜外麻醉老年患者30例，随机分血液稀释组（H组）和对照组（C组），每组各15例。硬膜外麻醉成功后，H组按50ml／min的速率输注4％琥珀酰明胶15ml·kg^-1，C组输乳酸林格氏液15ml·kg^-1。麻醉前、切皮前、术毕、术后4h监测并记录SBP、DBP、HR、CVP、HCT、血气及心肌肌钙蛋白。结果硬膜外麻醉后两组血压均下降，C组下降较H组明显，H组实施AHH后CVP明显升高，但基本在正常范围之内。两组术叶1各时点血气分析变化差异无硅著性。CTnⅠ在组内各时点及组间相应时点差异无显著性（P〉0．05），且CTnI始终处在低值（≤0．1ng·ml^-1）。结论一般情况良好，无心肺疾患的老年患者硬膜外麻醉下实施AHH，循环功能影响较小，心肌损伤不明显。Objective To investigate the effect of acute hypervolemic hemodilution （AHH）on circulate function and cardiac troponin Ⅰ（CTn Ⅰ ） in elderly patients under epidural anesthesia,and evalu- ate its safety. Methods 30 ASA Ⅰ -Ⅱ elderly patients under epidural anesthesia without cardiac and pulmonary disease were randomly divided into two groups： hemodilution group （H, n= 15） and control group （C,n = 15）. Group H,AHH was performed with 4% Gelafusine 15 ml/kg in fused at a rate of 50 ml/min before skin incision. Group C,in fused with Ringers lactate solution 15 ml/kg. Radial artery was cannulated for direct Bp monitoring and internal jugular vein was cannulated for CVP monitoring and infusing. Before anesthesia and skin incision, at the end of operation,4h after surgery, SBp, DBp, HR, CVP, Cardiac troponin I,Blood gas analysis and T were monitored and recorded. Results After epidural anesthesia （after AHH in group H） blood pressure was decreased in both groups. It decreased more significantly in group C. CVP was significantly higher after AHH in group H, but not notable mostly. CTn I showed little change during and after operation in both groups. Conclusion Epidural anesthesia AHH has little influence on circulate function and myocardial injury in elderly patients without cardial and pulmonary disease.

关 键 词：血液稀释 老年人 心肌肌钙蛋白 循环功能 

分 类 号：R54[医药卫生—心血管疾病]