不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响  

Effects of acute hypervolemic hemodilution on hemorrheology in patients with deep vein thrombosis

作　　者：王宇恒[1] 曾凡荣[2] 左会明[2] 王俊科[1] 

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳市110001 [2]黑龙江省佳木斯大学附属第一医院

出　　处：《中华麻醉学杂志》2009年第6期510-512,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨不同液体术前急性高容量血液稀释（AHH）对深静脉血栓病人血液流变学的影响。方法拟行股静脉取栓术病人30例，年龄40～64岁，栓塞时间〈48h，随机分为3组（n=10）：生理盐水组（NS组）、羟乙基淀粉组（HES组）和琥珀酰明胶组（GEL组）。麻醉诱导前分别静脉输注生理盐水、6％羟乙基淀粉（HES，200／0．5）或琥珀酰明胶40min，输注速率20ml·kg^-1·h^-1。分别于AHH前、后即刻采集静脉血样5ml，测定全血粘度高切变率、全血粘度低切变率、血浆粘度、红细胞压积、红细胞聚集指数和变形指数，并记录MAP、HR和SpO2。记录术中输液量和输血量。结果AHH前、后三组血液动力学指标均在正常范围内。与NS组比较，HES组AHH后即刻全血粘度高切变率、全血粘度低切变率和红细胞聚集指数降低，血浆粘度和红细胞变形指数升高，GEL组AHH后即刻全血粘度高切变率和低切变率降低，血浆粘度升高（P〈0．05或0．01）；与HES组比较，GEL组全血粘度低切变率、红细胞聚集指数升高，红细胞变形指数降低（P〈0．01）。结论6％羟乙基淀粉（200／0．5）和琥珀酰明胶术前AHH改善深静脉血栓病人血液流变学状态的效果优于生理盐水，且6％羟乙基淀粉的效果更优，可改善该类病人血液流动缓慢和血液高凝状态，降低了再次发生血栓的危险。Objective To investigate the effects of acute hypervolemic hemodilution （AHH） with different fluids on blood rheology in patients with deep vein （femoral and iliac） thrombosis. Methods Thirty ASA Ⅰ or Ⅱ patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups （ n = 10 each） ： group Ⅰ normal saline （NS） ; group Ⅱ 6% HES 200/0.5 （HES） ; group m gelofusine （GEL）. AHH was performed with normal saline, 6% HES or gelofusine infusion at 20ml·kg^-1·h^-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 μg/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 ml·kg^-1·h^-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated （VT 8 ml/kg, RR 12 bpm）. PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit （Hct）, whole blood viscocity （WBV） at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.

关 键 词：羟乙基淀粉 明胶 氯化钠 血液稀释 静脉血栓形成 血液流变学 

分 类 号：R614[医药卫生—麻醉学]