【摘要】 目的观察羟乙基淀粉(HES130/0.4)术前行中度急性高容量血液稀释(AHHD)联合术中控制性降压(CH)对椎间盘摘除术患者全身炎症反应(SIR)的影响。方法择期行椎间盘摘除术男性患者54例,随机均分为:复方乳酸钠组(Ⅰ组)、HES200/0.5组(Ⅱ组)和HES130/0.4组(Ⅲ组)。三组输注速率均为20ml/kg,30min输完。术中采用硝酸甘油行CH,维持MAP在65～70mmHg。分别于麻醉诱导前(T0)、手术开始前即刻(T1)、降压至目标值即刻(T2)、停止降压即刻(T3)及术毕(T4)抽取中心静脉血5ml,ELESA法检测各时点血浆肿瘤坏死因子α(TNF-α)、白细胞介素-8(IL-8)浓度,流式细胞术检测T0、T1、T4多形核白细胞(PMNL)凋亡数。结果与T0时比较,三组T1～T4时TNF-α、IL-8浓度和PMNL凋亡数显著高于T0时(P<0.05);Ⅱ组和Ⅲ组在T1～T4时TNF-α、IL-8均低于Ⅰ组(P<0.05)。T4时Ⅱ组和Ⅲ组PMNL凋亡数高于Ⅰ组(P<0.05),Ⅲ组明显高于Ⅱ组(P<0.05)。结论HES200/0.5和HES130/0.4均可降低椎间盘摘除术患者术中炎症反应,后者作用更显著。更多还原

【Abstract】 Objective To investigate the effects of the acute hypervolemic hemodilution(AHH) with hydroxyethyl starch combined with deliberate hypotension(CH) on systemic inflammatory response(SIR).Methods Forty-four patients were randomly divided into 3 groups with 18 cases each.AHH was carried out with lactated Ringer’s solution in group Ⅰ,HES 200/0.5 in groupⅡ or HES 130/0.4 in group Ⅲ in the dose of 20ml/kg infused within 30min before induction of general anesthesia.CH was induced with nitroglycerin hypotension to keep MAP 65-70mmHg during operaton.The blood samples were taken for the measurements of tumour necrosis factor(TNF)-α, interleukin-8(IL-8)and apoptosis of polymorphonuclear leukocyte (PMNL) before anesthesia induction (T0),at the time of Hct reaching to 28%-30%(T1),the time of target MAP (T2),the end of CH(T3) and the end of operation(T4).Results Compared to T0,the TNF-α,IL-8 and apoptosis of PMNL were increased at T1-T4 in three groups(P<0.05).TNF-α and IL-8 were lower in group Ⅱand Ⅲ than those in group Ⅰ(P<0.05).At T4,the number of apoptosis of PMNL was in an order of group Ⅲ >groupⅡ> groupⅠ(P<0.05).Conclusion AHH with HES 130/0.4 or HES 200/0.5 can attenuate the SIR in the patients undergoing intervertebral disk excision.,in respect of which HES 130/0.4 is better than HES 200/0.5.更多还原