术中自体输血及血液稀释氧代谢及血乳酸的变化  

EFFECTS OF HEMODILUTION ON OXYGENATION AND BLOOD LACTIC ACID DURING SURGERY

作　　者：詹鸿[1] 张秀燕[1] 黄焕娟[1] 陶红斌[1] 谭灿辉[1] 陈浩文[1] 苏志源[1] 

机构地区：[1]广州医学院附属市二人民医院麻醉科,510150

出　　处：《中国现代医学杂志》2002年第15期20-21,24,共3页China Journal of Modern Medicine

基　　金：广东省医学科研基金资助 (课题编号A2 0 0 0 5 67)

摘　　要：探讨术中自体输血期间血液稀释对氧代谢影响、血乳酸水平的变化及病人的耐受力。方法 :18例腹部及骨科全麻手术病人 ,年龄 (47.4± 14 .8)岁 ,体重 (5 6 .3± 6 .6 )kg ,ASAⅠ～Ⅱ级。采用急性等容性血液稀释和 /或血液回收机自体输血 ,行桡动脉穿刺置管及右颈内静脉穿刺置漂浮导管 ,分别于术前、输自体血前及输自体血后比较其血液动力学、氧代谢及动脉血乳酸的变化。结果 :术中失血 (10 36 .36± 5 16 .2 8)ml,自体输血量 (6 2 7.2 8± 2 93.5 7)ml,血液稀释程度 :HCT0 .2 3± 0 .0 3,此时HB ,HCT ,SVRI值明显下降 ,PCWP及CI值明显升高 ,MAP和HR变化不明显 ,PvO2 和SvO2 明显下降 ,DO2 ,VO2 ,O2 ER、LacticAcid变化不明显 ,回输自体血后HCT ,HB明显回升虽未达术前水平 ,但PvO2 ,O2 ER和LacticAcid变化不明显。结论 :术中血液稀释 ,HCT在 2 3%时 ,对心肺功能良好的病人是安全的 ,对氧代谢无明显影响。Objective:To investigate the oxygenation, values of blood lactic acid and the tolerance capability of patients during hemodilution. Methods:We studied 18 cases of surgical patients, age of 47.4±14.8 years, Bodyweight of 56.3±6.6 kg, ASAⅠ～Ⅱdegree. Acute isovolume hemodilution and/or cell saver were used. Swan Ganz's cathethers were used and the hemodynamics and oxygenation were calculated via the AS/3 monitor.Results:Blood loss during the surgery was 1036.36±518.28ml, range of hemodilution of HCT was 0.23±0.03, volume of autolougus transfusion was 627.28±293.57ml, values of HB, HCT, SVRI, PvO 2 and SvO 2 were significantly decreased and PCWP and CI increased,and no significant changes of DO 2,VO 2,O 2ER and lactic acid were found at the end of hemodilution. At the end of surgery, no significant changes of PvO 2,O 2ER and lactic acid were found, although the values of HCT and HB were still lower than those before surgery. Conclusion:There are no significant effects of hemodilution (HCT=0.23) on oxygenation of the patients in ASA Ⅰ～Ⅱdegree.

关 键 词：自体输血 外科手术 血液稀释 氧代谢 血乳酶 

分 类 号：R605[医药卫生—外科学] R457.1[医药卫生—临床医学]