高容血液稀释对门脉高压手术患者凝血功能的影响  

Effect of hypervolemic hemodilution on homestasis in patients with portal hypertension

作　　者：王祥瑞[1] 杨跃武[1] 李雯[1] 杭燕南[1] 孙大金[1] 

机构地区：[1]上海第二医科大学仁济医院麻醉科,上海200127

出　　处：《上海第二医科大学学报》2004年第3期199-202,共4页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的 研究输注不同晶体、胶体液高容血液稀释对门脉高压手术患者凝血功能的影响。方法 32例门脉高压行脾切除(断流或分流)手术患者随机分为贺斯组(组Ⅰ,n=12)、血定安组(组Ⅱ,n=10)及乳酸钠林格液组(组Ⅲ,n=10)。麻醉前用药物改善凝血功能,各组于麻醉诱导前10 min分别输入上述三种液体1 h行扩容治疗,扩容速度为15 mL·kg^(-1)·h^(-1)。于麻醉前、诱导后10 min、扩容开始后1 h和4 h分别采集静脉血2 mL,用凝血弹性仪(TEG)测定凝血功能。桡动脉采血,分析电解质、Hb、HCT、乳酸、血糖等生化指标及酸碱度。结果 病人术前血气检查值基本正常。扩容后三组pH值、电解质水平无明显变化。扩容后1 h,组Ⅰ、Ⅱ的Hb及HCT均显著下降(P<0.05),三组乳酸浓度均呈升高趋势(P<0.05),但组Ⅰ、Ⅱ明显低于组Ⅲ,且组Ⅰ显著低于组Ⅱ(P<0.05);三组血糖水平均呈显著升高趋势(P<0.05)。HCO_3^-的变化趋势为:扩容后组Ⅰ、Ⅱ的HCO_3^-浓度呈上升趋势,而同时相的组Ⅲ HCO_3^-浓度呈下降趋势(P<0.05)。麻醉诱导扩容后,R、K值随扩容时间的延长逐渐缩小,alpha角度、MA和G值逐渐增大(P<0.05),但仍低于正常值范围,尚未恢复到正常水平;CL30值逐步得到改善,三组均恢复到大于或等于95％水平(P<0.05),扩容后4 h时,组Ⅰ。Objective To observe the effects of hypervolemic hemodilution with gelofusine, Ringer' s solution on homestasis in patients with portal hypertension. Methods Thirty-two ASA class Ⅱ - Ⅲ patients of either sex , undergoing elective lienectomy or portal caval shunt, were randomly divided into 3 groups; 1.6%HES 200/0.5 group (n =12) , Ⅱ gelofusine group(n =10) , Ⅲ Ringer's solution group(n = 10). The radical artery and right internal jugular vein were cannulated. 10 min before anesthesia, and 6% HES 200/0. 5, Gelofusine and Ringer' s solution were infused respectively at the rate of 15 mL·kg-1·h-1 for 1h. Arterial blood samples were taken before anesthesia, 10 min after anesthesia, 1 h, 4 h after hemodilution. Two mL venous blood was taken for measurement of coagulation with TEG as well as for the determination of blood pH glucose, electrolytes and lactic acid concentration. Results In blood analysis, before anesthesia, blood glucose, electrolytes and blood pH were normal. After hemodilution, Hb and HCT significantly decreased in all the three groups (P < 0. 05). Blood lactic acid in three groups increased, with in group Ⅲ significantly higher than the other two groups (P <0. 05). HCO3- content increased in group Ⅰ and group Ⅱ , but decreased in group Ⅲ; there were significant differences between them ( P < 0. 05 ) as to indices of coagulation in TEC before anesthesia, R, K (which reflects the function of fibrinogen) prolonged and the alpha angle, MA, G decreaed, which reflect the function of platelet; after anesthesia and hemodilution, R, K became shorter and the alpha angle , MA , G became bigger ( P < 0. 05) , but still lower than normal, this indicate that the functions of fibrinogen and platelet had recovered but still couldn't reach normal levels; CL30 raised to 95% from <95% (before hemodilution) in all the three groups, this indicate that dissolution of fibrin was near normal. In comparison, only G in group Ⅰ and group Ⅱ was significantly higher than in group Ⅲ (P <0.

关 键 词：高容血液稀释 门脉高压 凝血功能 凝血弹性仪 血流动力学 肝硬化 

分 类 号：R614[医药卫生—麻醉学]