羟乙基淀粉术前血液稀释联合术中控制性降压对全身炎症反应的影响  

Effects of acute hypervolemic hemodilution with 6% hydroxyethyl starch combined with deliberate hypotension on systemic inflammatory response

作　　者：田新民[1] 任建军[1] 夏建光[1] 申作娟 马玉武[1] 赵煜毅[1] 

机构地区：[1]山东省德州市人民医院麻醉科,253000 [2]山东省陵县妇幼保健院妇科

出　　处：《临床麻醉学杂志》2009年第4期306-308,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察羟乙基淀粉(HES130/0.4)术前行中度急性高容量血液稀释(AHHD)联合术中控制性降压(CH)对椎间盘摘除术患者全身炎症反应(SIR)的影响。方法择期行椎间盘摘除术男性患者54例,随机均分为:复方乳酸钠组(Ⅰ组)、HES200/0.5组(Ⅱ组)和HES130/0.4组(Ⅲ组)。三组输注速率均为20ml/kg,30min输完。术中采用硝酸甘油行CH,维持MAP在65～70mmHg。分别于麻醉诱导前(T0)、手术开始前即刻(T1)、降压至目标值即刻(T2)、停止降压即刻(T3)及术毕(T4)抽取中心静脉血5ml,ELESA法检测各时点血浆肿瘤坏死因子α(TNF-α)、白细胞介素-8(IL-8)浓度,流式细胞术检测T0、T1、T4多形核白细胞(PMNL)凋亡数。结果与T0时比较,三组T1～T4时TNF-α、IL-8浓度和PMNL凋亡数显著高于T0时(P<0.05);Ⅱ组和Ⅲ组在T1～T4时TNF-α、IL-8均低于Ⅰ组(P<0.05)。T4时Ⅱ组和Ⅲ组PMNL凋亡数高于Ⅰ组(P<0.05),Ⅲ组明显高于Ⅱ组(P<0.05)。结论HES200/0.5和HES130/0.4均可降低椎间盘摘除术患者术中炎症反应,后者作用更显著。Objective To investigate the effects of the acute hypervolemic hemodilution（AHH） with hydroxyethyl starch combined with deliberate hypotension （CH） on systemic inflammatory response（SIR）. Methods Forty-four patients were randomly divided into 3 groups with 18 cases each. AHH was carried out with lactated Ringer＇s solution in group Ⅰ , HES 200/0.5 in group Ⅱ or HES 130/0.4 in group Ⅲ in the dose of 20 ml/kg infused within 30 min before induction of general anesthesia. CH was induced with nitroglycerin hypotension to keep MAP 65-70 mmHg during operaton. The blood samples were taken for the measurements of tumour necrosis factor（TNF）-α, interleukin-8（ IL-8 ）and apoptosis of polymorphonuclear leukocyte （PMNL） before anesthesia induction （T0）,at the time of Hct reaching to 28%-30%（T1 ）,the time of target MAP （T2）,the end of CH（T3 ） and the end of operation（T4 ）. Results Compared to To, the TNF-α,IL-8 and apoptosis of PMNL were increased at T1-T4 in three groups （P〈0.05）. TNF-α and IL-8 were lower in group Ⅱ and Ⅲ than those in group Ⅰ （P〈0.05）. At T4 ,the number of apoptosis of PMNL was in an order of group Ⅲ〉 group Ⅱ 〉group I （P〈0.05）. Conclusion AHH with HES 130/0.4 or HES 200/0.5 can attenuate the SIR in the patients undergoing intervertebral disk excision. ,in respect of which HES 130/0.4 is better than HES 200/0.5.

关 键 词：羟乙基淀粉 血液稀释 控制性降压 炎症反应 

分 类 号：R614[医药卫生—麻醉学]