术前急性高容量血液稀释对患者内稳态的影响  

Effect of acute hypervolemic hemodilution on body internal environment homeostasis:Comparative study on different agents

作　　者：李前辉 王玲 吴青华 胡百奇 

机构地区：[1]150医院麻醉科,河南洛阳471031

出　　处：《实用医药杂志》2010年第1期21-24,共4页Practical Journal of Medicine & Pharmacy

摘　　要：目的比较乳酸钠林格液、6%羟乙基淀粉130/0.4、4%琥珀酰明胶用于术前急性高容量血液稀释(AHHD)对患者内稳态的影响。方法30例择期脑膜瘤手术患者随机分为乳酸钠林格液组(Ⅰ组)、6%羟乙基淀粉130/0.4组(Ⅱ组),4%琥珀酰明胶组(Ⅲ组),每组10例。麻醉诱导前,分别用相应液体以20ml/kg·h的速度AHHD30min,诱导时及以后继续用相应液体20ml/kg·h的速度AHHD30min后手术。并于AHHD前(T1)、AHHD毕(T2)、AHHD后60min(T3)、AHHD后120min(T4)采集静脉血待测红细胞压积(Hct)、血红蛋白(Hb)、凝血酶原时间(PT)、凝血酶时间(TT)、部分活化凝血活酶时间(APTT)、纤维蛋白原(FBG)以及Ⅷ因子、VWF及放免法测定血清β2-微球蛋白(β2-MG)含量,并于上述各时间点采集动脉血测血气及电解质。结果3组患者AHHD后各时间点与T1比较Hct、Hb均降低(P<0.01)。3组患者AHHD后各时间点与T1比较PT、TT、APTT、FBG、Ⅷ、VWF均有明显变化(P均<0.05),其中TT、FBG、Ⅷ、VWF未超出正常值范围,而PT、APTT已超出正常值范围。APTT的变化,Ⅱ组、Ⅲ组与Ⅰ组有显著性差异(P<0.01)。3组患者AHHD后各时间点与T1比较β2-MG的含量无明显变化(P>0.05)。3组患者AHHD后与T1比较,pH、K+无明显变化(P>0.05),HCO3-、PaCO2均明显降低(P<0.01)。AHHD毕与T1比较,Na+、Cl-均明显升高(P<0.01),Ca2+的变化Ⅱ组、Ⅲ组均显著降低(P<0.01)。结论术前AHHD能维持血流动力学的稳定;6%羟乙基淀粉130/0.4和4%琥珀酰明胶用于术前急性高容量血液稀释对患者凝血功能有一定影响,但临床观察无出血增加现象。6%羟乙基淀粉130/0.4和4%琥珀酰明胶用于术前急性高容量血液稀释对术前肾功能正常患者的肾功能没有明显影响。3组AHHD后血气指标无明显变化。3组AHHD后Cl-均增加,而6%羟乙基淀粉130/0.4组和4%琥珀酰明胶组AHHD后Ca2+降低,应予以注意,必要时及时补充钙离子。Objective To compare the effects of acute hypervolemic hemodilution by Lactated Ringer＇s solution,6% Hydroxyethyl Starehl30/0.4 and 4% Succinylated Gelatin on body internal environment homeostasis. Method Thirty patients undergoing scheduled meningioma operation were randomly divided into 3 groups： Group Ⅰ（AHHD with lactated Ringer＇s solution）, Group Ⅱ （AHHD with 6% hydroxyethyl starch 130/0.4）, Group Ⅲ （AHHD with 4% succinylated gelatin）, with 10 in each group. AHHD was performed by infusing 20 ml/kg·h solution 30 minutes before induction and infusing 20 ml/kg·h solution 30 minutes during and after induction, then the operation was performed. The venous blood samples were collected before AHHD （TI）, at the end of AHHD （T2）, 60 minutes after AHHD （T3）, 120 minutes after AHHD （T4） respectively for determining HCT, HB, PT, TT, APTT, FBG, Ⅷ, VWF and β2-MG; arterial blood samples before AHHD （T1）, at the end of AHHD （T2）, 60 minutes after AHHD （T3）, 120 minutes after AHHD （T4） were respectively collected for determining blood gas and electrolytes. Result In changes of HCT, HB there were significant differences between after AHHD and before AHHD （P〈0.01）; in changes of PT, TT, APTF, FBG, Ⅷ, VWF there were significant differences between after AHHD and before AHHD （P〈0.05）, and TT, FBG, Ⅶ, VWF were all at the normal level, but PT, APTT were beyond the normal level; in changes of APTT there were significant differences between group Ⅱ, Ⅲand group Ⅰ （P〈0.01）. In changes of 132-MG, compared with Tl,there were no significant differences at T2, T3, T4 （P〉0.05）; in changes of pH and K＋, compared with T1,there were no significant differences at T2, T3, T4 （P〉0.05）, compared with T1, HCO3-, PaCO2 decreased significantly after AHHD （P〈0.01）. Compared with T1, Na＋, Cl- increased significantly at the end of AHHD（P〈0.01）; Ca2＋ decreased significantly at the end of AHHD in group Ⅱ and group Ⅲ （P〈0.01）. Co

关 键 词：急性高容量血液稀释 内稳态 术前准备 

分 类 号：R619.9[医药卫生—外科学]