摘要
目的 研究急性等容量血液稀释结合控制性降压对血容量、心脏前负荷、肺血管外肺水和血浆胶体渗透压的影响。方法 ASAⅠ～Ⅱ级的髋关节手术病人24例,随机均分为组Ⅰ(对照组)和组Ⅱ(降压组)。两组均采用硬膜外阻滞复合全身麻醉。组Ⅱ术前进行等容血液稀释,术中施行控制性降压,并进行自体血回输。术中测定静脉血细胞比容(Hct)和中心静脉压(CVP),经股动脉放置PiCCO(PV2014L13,Pulson Medical Systems)热稀释导管,监测动脉压(BP)、心脏指数(CI)、每搏心排量(SV)、外周阻力(SVR)、心脏舒张末期容量((3EDV)、胸内血容量(ITBV)和血管外肺水容积量(EVIW)。结果 组Ⅰ病人平均输库血量和出血量明显高于组Ⅱ;两组病人的Hct分别由基础值(42±2.3)％和(43±2.5)％降为(32±2.8)％和(39±3.2)％,差异有显著意义;其余指标差异无显著性。结论 6％HES(200/0.5)扩容效果持久、稳定;血液稀释结合控制性降压及自体血回输既保持了血容量和心脏前负荷,同时不增加血管外肺水,另外可以明显减少术中出血;血液稀释后Hct仍大大超过最低安全水平线,具有很高的安全性。
Purpose: To study the effects of deliberated hypotension combined with acute isovolemic hemodilution on blood volume, cardiac preload, extravascular lung water and plasma oncotic pressure in patients undergoing total hip replacement (THR). Methods: Twenty-four ASA grade I or II adult patients undergoing elective THR were divided into two groups randomly: group I (control group) and group II (hypotensive group). All patients received epidural block combined with general anesthesia. In group II, acute isovolemic hemodilution with hematocrit (Hct) of 30 % was accomplished by exchanging whole blood with 6 % Hydroxyethyl starch (6 % HES) and lactated Ringer's solution. Deliberated hypotension was induced and maintained with labetalol and nitroglycerin. All patients in group II received cell-saver for collecting loss blood. MAP, HR, CVP, CI, SVR, GEDV, ITBV and EVLW were measured continuously with PiCCO deviced during operation. Intraoperative blood loss, volum of blood to be transfused during operation, volume of processed blood and postoperative Hct were recorded and compared between two groups. Results: There were no difference observed in the baseline values of MAP, HR, CI SVR, EVLW and ITBV between two groups. In group I, the average volume of blood lose and blood to be transfused during operation was higher than those in group II. Hct of group I decreased from (42 ± 2.3) % to (32 ± 2.8) % and the hypotensive group from (43 ± 2.5) % to (39 ± 3.2) %. There was no significant difference in hemodynamic values, plasma oncotic pressure and EVLW before, during and after operation. Conclusions: 6 % HES is very safe and efficient in blood volume expansion. Deliberated hypotension combined with acute isovolemic hemodilution and cell-saver can obviously decrease the volume of blood loss during operation. This technique is very safe. Hct can also be kept above the lowest safe level after hemodilution. Not only this technique can maintain both blood volume and cardiac preload, but also it doesn't increase EVLW.
出处
《复旦学报（医学版）》
EI
CAS
CSCD
北大核心
2003年第4期388-390,共3页
Fudan University Journal of Medical Sciences
