急性高容量血液稀释对全髋关节置换术患者血清干扰素诱导蛋白10表达的影响  

Effect of acute hypervolemic hemodilution on expression of serum chemokine interferon-inducible protein I0 in patients undergoing total hip replacement.

作　　者：唐琦峰[1] 郝跃峰[2] 钱燕宁[3] 王忠云[3] 张洪兴[3] 

机构地区：[1]江苏省苏州市立医院(北区)麻醉科,215008 [2]江苏省苏州市立医院(北区)骨科,215008 [3]南京医科大学第一附属医院麻醉科

出　　处：《中国综合临床》2009年第12期1233-1235,共3页Clinical Medicine of China

基　　金：江苏省医学重点人才资助项目（RC2002058）

摘　　要：目的探讨羟乙基淀粉急性高容量血液稀释对全髋关节置换术患者血清干扰素诱导蛋白10（IP-10）表达的影响。方法选择ASAⅠ、Ⅱ级择期全髋关节置换术患者20例，随机分为羟乙基淀粉组（HES组）和乳酸钠林格液组（LR组），每组各10例。2组患者均采用腰麻-硬膜外联合麻醉，于麻醉后以20mL／kg的剂量和30ml／（kg·h）的速率分别输入6％羟乙基淀粉和乳酸钠林格液。分别记录手术时间、术中出血量和输血量。分别在麻醉前（T0）、手术开始前（T1）、手术开始后30min（T2）、手术结束（T3）采外周静脉血测定IP-10含量。结果HES组术中出血量、输血量显著少于LR组[（560±90）ml与（810±110）ml、（200±100）ml与（600±200）ml，P均〈0．05]。与T0时比较，HEs组与LR组T2、T3时IP-10浓度明显升高（P均〈0．05）；HES组他、13时IP-10浓度明显低于LR组[（62．8±13．6）ng／L与（77．3±13.8）．g／L、（65．4±10．2）ng／L与（89．9±15．1）ng／L，P均〈0．05]。结论全髋关节置换术患者用羟乙基淀粉200／0．5进行急性高容量血液稀释，不仅可以减少术中输血，而且可以有效抑制IP-10浓度的升高，有利于机体免疫功能的稳定。Objective To study the effect of acute hypervolemic hemodilution on expression of serum chemokine interferon-inducible protein 10 in patients undergoing total hip replacement. Methods Twenty ASA I or II patients undergoing elective total hip replacement were randomly divided into 2 groups （n = 10 each ） ： HES group and LR group. The patients in HES group received 6% HES 20 ml/kg in rate of 30 mE/（ kg·h） after anesthesia. The patients in LR group received Ringer＇s solution 20 ml/kg in rate of 30 ml（ kg·h） after anesthesia. The blood loss, blood transfusion and the time of operation were recorded. Venous blood samples were taken before anesthesia （T0） , at the begining of operation （T1） , 30 min after operation （T2） , and at the end of operation（T3） , in determination of serum chemokine interferon-inducible protein 10. Results The blood loss and the blood transfusion in HES group were （560 ±90）ml and （200±100）ml,those were significantly lower than that in LR group[ （810 ±110）ml and （600± 200） ml]. The IP-10 concentrations were significantly increased at T2 ～ T3 as compared to baseline value at TO in both groups, but were higher in LP group[ （77.3 ±13.8） ng/L and （89.9± 15.1） ng/L] than those in HES group[ （62.8± 13.6）ng/L and （65.4 ± 10.2）ng/L,P〈0.05]. Conclusions Acute hyperv- olemie hemodilution can abate blood loss and blood transfusion during total hip replacement operation. Preoprative infusion with hydroxyethyl starch can attenuate the immunological depression during operation and anesthesia.

关 键 词：羟乙基淀粉 急性高容量血液稀释 炎症趋化因子 全髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]