经食道超声多普勒监测在非心脏病老年患者行急性高容血液稀释中的应用  

Transesophageal Doppler monitoring of acutehypervolemic hemodilution tolerance in elderly patients without known cardiac disease

作　　者：王永徽 刘广林[1] 陈敏[1] 董海龙[1] 

机构地区：[1]第四军医大学西京医院麻醉与围术期医学科,陕西西安710032

出　　处：《麻醉安全与质控》2017年第1期12-16,共5页Perioperative Safety and Quality Assurance

基　　金：国家自然科学基金(81371510)

摘　　要：目的研究对老年患者行急性高容血液稀释(HHD)时血流动力学的变化。方法选取20例无心脏病史的拟行麻醉患者根据年龄分成2组(每组10例)。所有入试患者在术前接受相同的HHD处理(静脉输注羟乙基淀粉200/0.5,15 mL/kg)。采用经食管多普勒超声监测(HemoSonic^(TM))测量在平稳期和稀释扩容不同程度时心排量(CO)、每搏量(SV)、心指数(CI)和心率(HR)等血流动力学参数值,此外记录血细胞比容(Hct)、血红蛋白(Hb)、血气及心电变化。结果所有患者均未发生任何并发症。两组患者间的生化检查数据、Hct、血气均无统计学差异。HHD导致对照组(≤55岁)的心排量升高6%~27%,老年组(≥65岁)心排量降低3%~9%。每搏量和心率的变化结果导致心排量的改变。对照组HR下降和SI升高,而老年组心率无明显改变。血液稀释后全身外周血管阻力值(TSVR)对照组患者下降约20%,而老年组升高约19%。血液稀释后老年组最大加速度(ACC)轻微下降,对照组左心室射血时间(LVET)延长。结论 HHD不适用于无心脏病史的老年患者。HHD可以导致由SV下降导致的CO下降。同时结果表明老年患者行HHD时心血管代偿能力有限。Objective Preoperative acute hypervolemic hemodilution （ HHD） is used during anesthesia to reduce the blood loss fromintraoperative bleeding. However,HHD tolerance is not well defined in elderly patients. The aim of the present study is to clarify thehemodynamic influence of HHD on elderly patients. Methods Twenty anesthetized patients without evidence of heart diseases were alloca-ted into two groups （ n = 10） by age. All patients underwent hypervolemic hemodilution procedure before surgehydroxyethylstarch 200/0. 5. Hemodynamic parameters （ cardiac output,stroke volume, cardiac index, and heart rate, ured by transesophageal Doppler monitoring （ HemoSonicTM ） during a stabilization period and at each levelsglobin ,blood gas and ECG were also monitored during hemodilution. Results No complications occurred in any patients. There were nodifferences in biometric data,H c t ,or blood gases between two groups. HHD resulted in an increase in cardiac output （CO ） by 6% - 27% in the Control group （ ≤ 55 years old） , but a decrease in CO by 3% -9% in the Elder group （ ≥65 years old） . The change of CO was solely the result of changes in stoke volume （SV） because the heart rate （HR） was decreased （Congroup）. The stroke index （ SI） also showed an increasing tendency in Control group rather than in Elder group. The systemic vascular resistance （TS V R） decreased in the Control group by about 20% but increased in the Elder group by about 19% after hemodilution. The maximum acceleration （ACC） slightly decreased in the Elder group after hemodilution. The left ventricular ejection time （LVET ） showed an increase tendency after hemodilution in the Control group. Concliuion The described regimen of acute hypervolemic hemodilution was notwell tolerated during anesthesia by elderly patients without heat diseases. It leads to a decrease in cardiaby a decrease in stroke volume. The results indicate that elderly patients have a limited compen

关 键 词：高容血液稀释 多普勒超声 心排量 经食道 老年患者 

分 类 号：R614[医药卫生—麻醉学]