急性高容血液稀释对老年心脏手术病人脑氧合功能的影响  

Effects of acute hypervolemic hemodilution on cerebral oxygenation in aged patients undergoing coronary artery bypass grafting

作　　者：王祥瑞[1] 陈涌鸣[1] 李雯[1] 陈杰[1] 杭燕南[1] 孙大金[1] 

机构地区：[1]上海第二医科大学附属仁济医院麻醉科,200001

出　　处：《临床麻醉学杂志》2002年第6期289-292,共4页Journal of Clinical Anesthesiology

基　　金：上海市卫生系统"百人计划"基金资助 (BR0 11)

摘　　要：目的　观察急性高容性血液稀释 (AHHD)对老年心脏手术病人脑氧合功能的影响并探讨其可能的作用机制。方法　 2 4例冠状动脉搭桥术 (CABG)的病人 ,ASAⅠ～Ⅱ级 ,随机分为老年扩容组、未扩容组和中青年扩容组。扩容组诱导时 1小时内经颈内静脉推注 6 %贺斯溶液 1 0ml/kg ,同时静注硝酸甘油 0 5μg·kg- 1 ·min- 1 。分别于术前、诱导后 5分钟、扩容止及主动脉插管时监测血液动力学指标 ,测定动、静脉血乳酸浓度 ,脑血氧饱和度 (SjvO2 ) ,脑血氧分压 (PjO2 )和脑血流速率。结果　 (1 )老年扩容组的PAP较术前显著增高 (P <0 0 5) ,但与其他两组相比无显著差异。 (2 )未扩容组的SjvO2 ,CBF/CMRO2 在主动脉插管时较术前显著降低 (P <0 0 1 ) ,与扩容组相比也显著减少 (P<0 0 5) ;而老年扩容组SjvO2 较术前及另外两组均显著增加 (P <0 0 5) ,CBF/CMRO2 无明显变化。(3)脑血流速率在中青年扩容组病人均显著高于另外两组 (P <0 0 5)。 (4)脑乳酸净生成量 (ADVL)三组间无显著差异 (P >0 0 5)。结论　AHHD对老年手术病人脑氧合功能具有一定的保护作用。Objective To observe the effects of acute hypervolemic hemodilution (AHHD) on cerebral oxygenation in the aged patients undergoing coronary artery bypass grafting(GABG)and study the possible mechanism.Methods 24 patients scheduled for CABG,ASA physical status of grades Ⅰ～Ⅱ,were randomly allocated to three groups:group Ⅰ(the aged,receiving AHHD, n= 9);group Ⅱ(the aged as control, n= 8);group Ⅲ(the middle age,receiving AHHD, n= 7).AHHD was produced by infusion of 6% HAES at a dose of 10ml/kg with 1h during induction and nitroglycerin was infused at a speed of 0 5μg·kg -1 ·min -1 as well.Lactic acid concentration,cerebral oxygen saturation,partial pressure of oxygen,velocity of blood stream of the middle cerebral artery,and the hemodynamic parameters were monitored before anesthesia,at 5 min after induction,after AHHD and the time of aortic cannlation respectively.Results (1)After AHHD,PAP increased markedly in group Ⅰ ( P< 0 05),which was not significantly different from that in group Ⅱ or Ⅲ.(2)SjvO 2 and CBF/CMRO 2 were distinctly decreased during the time of aortic cannlation compared with those before anesthesia in group Ⅱ ( P< 0 01),and less than those in the other groups ( P< 0 05).During the time of aortic cannlation,SjvO 2 of group Ⅰ increased significantly in group Ⅰ compared with that before operation and that of the other groups ( P< 0 05),but CBF/CMRO 2 was not markedly changed.(3)Velocity of blood stream of the middle cerebral artery in group Ⅲ was significantly higher than that in group Ⅰ and Ⅱ ( P< 0 05).(4)Net production of lactic acid was not significantly different among the three groups.Conclusion AHHD is beneficial to the protection of cerebral oxygenation in the geratic patients undergoing CABG.

关 键 词：急性高容血液稀 心脏手术 影响 老年人 脑氧合功能 血液动力学 

分 类 号：R614[医药卫生—麻醉学]