急性非等容量血液稀释用于围术期老年患者的可行性  

Acute non-isovolemlc hemodilution during operation In the elderly patients

作　　者：丁明[1] 蒋豪[1] 王婷[1] 薛张纲[1] 朱小平[1] 吴民慧[1] 

机构地区：[1]复旦大学中山医院麻醉科,上海市200032

出　　处：《中华麻醉学杂志》2003年第5期343-346,共4页Chinese Journal of Anesthesiology

摘　　要：目的评估老年患者使用非等容量血液稀释(ANIH)的有效性及安全性,并与急性高容量血液稀释比较。方法38例老年患者,年龄65～80岁,ASA Ⅰ～Ⅱ级,随机分为两组:ANIH组(Ⅰ组),AHH组(Ⅱ组)。均采用硬膜外复合全麻。全麻诱导同时快速补充6％羟乙基淀粉1 000～1 200ml和乳酸林格氏液500 ml(25％～30％循环血量),Ⅰ组患者在诱导前采血400～600 ml(循环血量的10％～15％),并于手术结束前或预计Hct<24％予以回输。监测HR、BP、CVP、ST-T的变化,并抽血检测围术期Hct、胶体渗透压、动脉血乳酸的水平。结果 两组患者围术期生命体征平稳,诱导后两组各有16.7％(I组3/18)和15.O％(Ⅱ组3/20)的患者出现一过性的低血压,但两组患者CVP在血液稀释后均显著升高,Ⅱ组的升幅显著高于Ⅰ组(P<0.01)。Ⅱ组中有1例出现房颤。血常规检测提示,ANIH组的患者达到了中度血液稀释的目的(稀释后Hct:29.9％±3.9％),而AHH组仅可达到轻度血液稀释(稀释后Hct:32.9％±2.9％);手术结束时ANIH组的Hct显著高于AHH组分别为:31.5％±5.1％和27.7％±3.6％(P<0.01),而两组的出血量、各时段的胶体渗透压和动脉血乳酸水平无显著变化,均在正常值范围内。结论 ANIH稀释效率高,容量负荷干扰小,红细胞保护程度高,较AHH有更多的安全性和有效性,适合于老年患?Objective Elderly patients with reduced cardiac function are not considered good candidates for acute isovolemic hemodilution ( AIH) and acute hypervolemic hemodilution ( AHH) significantly increases preload in these patients. We tried to develop an in-between technique, acute non-isovolemic hemodilution (ANIH). The purpose of this study was to evaluate the effectiveness and safety of ANIH in the elderly patients in comparison with AHH.Methods Thirty-eight ASA Ⅰ -Ⅱ patients of both sexes, aged between 65-80 yr, undergoing elective surgery were enrolled in this study. Their preoperative Hct was > 35 % and the intraoperative blood loss was expected to be 800-1 600 ml. The operations were performed under combined general-epidural anesthesia. General anesthesia was induced with fentanyl 2-4 μg·kg-1 , thiopentone 5 mg·kg-1 and succinylcholine 1.5mg· kg-1 and maintained with isoflurane inhalation and intermittent iv boluses of vecuronium. Epidural anesthesia was performed at T5-6 (thoracic surgery), T10-11 (upper abdominal surgery) or L3-4 (lower abdominal surgery) . A mixture of 0.1% lidocaine +0.2% dicaine was used for epidural block during operation. The patients were randomly divided into 2 groups: (1) ANIH group ( n = 18) and (2) AHH group ( n = 20) . Blood volume (BV) was calculated according to following formula: BV (ml) (male) = Height (cm)× 28.5 + Body weight (kg) × 31.6 - 2 820,BV(ml) (female) = Height(cm)× 16.25 + Body weight (kg) × 38.46 - 1 369. 1 000-1 200 ml of 6% HES (200/0.5) and 500 ml of lactated Ringer's solution (about 25%-30% of BV) were infused at a rate of 50ml·min-1 when induction of anesthesia was started in both groups. In group I (ANIH) 400-600 ml of blood (about 10%-15% of BV) was removed through radial artery before induction of anesthesia. The removed blood was reinfused at the end of surgery. Vital signs (BP,HR,CVP and ST-T changes) , Hct, oncotic pressure and arterial blood lactate concentration were monitored during operation. Results The vital signs were fairly stable dur

关 键 词：非等容量血液稀释 老年人 硬膜外复合全身麻醉 羟乙基淀粉 乳酸林格氏液 

分 类 号：R614[医药卫生—麻醉学]