复方乳酸钠血液稀释时的容量动力学特征  

Volume kinetics of lactated Ringer′s solution during blood hemodilution

作　　者：昝莉莉[1] 嵇富海[2] 张俊峰[3] 

机构地区：[1]苏州市立医院(本部)麻醉科,215006 [2]苏州大学附属第一医院麻醉科 [3]复旦大学附属中山医院麻醉科

出　　处：《江苏医药》2009年第12期1453-1455,I0001,共4页Jiangsu Medical Journal

摘　　要：目的探讨复方乳酸钠(LR)血液稀释时在体内的容量动力学特征。方法20例手术患者随机均分为两组,Ⅰ组行高容血液稀释(HVHD),30 min内恒速输注LR 30 ml/kg,继续观察60min后进行全麻诱导。Ⅱ组行等容血液稀释(NVHD),先行采血10 ml/kg,后按Ⅰ组方法输注LR。输液前及输液开始后的90 min内,每5分钟测定血红蛋白(Hb)及红细胞压积(Hct),并记录总尿量及血流动力学数据。用容量动力学数学模型和物质守恒定律处理数据。结果B组容量增加和容量扩张效力显著大于Ⅰ组(P<0.05)。Ⅰ组输注结束时的液体保留率只有38%,明显低于Ⅱ组的60%(P<0.05)。一级容量动力学分析结果:Ⅰ组的目标容积(V)、清除率(Kr)明显比Ⅱ组大(P<0.05)。二级容量动力学分析结果:Ⅰ组的中央室目标容量(V1)、周边室目标容量(Kr)和液体转移系数(Kt)也明显比Ⅱ组大(P<0.05)。结论与HVHD比较,NVHD容量扩张效力高。Objective To study the cheracteristics of volume kinetics of lactated Ringer＇s solution（LR） during blood hemodilution. Methods Twenty patients undergoing selective surgery were randomly divided into two groups with 10 cases each. High-volume hemodilution（HVHD） was used in group Ⅰ , in which LR 30 ml/kg was infused at a constant rate within 30 min. Normal volume hemodilution（NVHD） was used in group Ⅱ ,in which LR 30 ml/kg was infused as in group Ⅰ after withdrawing whole blood 10 ml/kg. Hemoglobin（Hb） and hematoeit（Hct） were measured every 5 min during LR infusion and 60 min thenafter. Haemodynamic parameters and urine output were recorded as well. The volume kinetics was calculated according to the equation of mass balance. Results The volume increase and volume expansion efficacy （VEE） in group Ⅱ were significantly greater than those in group Ⅰ（P〈0.05）. The volume residual rate of group Ⅰ was less than that of group Ⅱ （380/oo vs. 60%） （P〈0. 05 ）. The values of target volume （V）, clearance rate （ Kr ）, central target volume（V1）, peripheral target volume （Kr） and transferal rate （Kt） were all significantly greater in group I than those in groupⅡ （P〈0. 05）. Conclusion The VEE of NVHD is higher than HVHD.

关 键 词：血液稀释 复方乳酸钠 容量动力学 

分 类 号：R614[医药卫生—麻醉学]