【作者】 柯剑娟；

【导师】 王焱林；

【作者基本信息】 武汉大学 ， 麻醉学， 2004， 硕士

【摘要】 目的：本研究通过观察聚明胶肽注射液（Polygelatine injection）作为血浆代用品用于急性等容血液稀释时血流动力学、氧供、氧耗、动脉血乳酸盐、血液流变学、血电解质及凝血功能各指标的变化，并与目前常用的血浆代用品中分子羟乙基淀粉（hydroxyethyl starch HAES）进行了比较，探讨其在临床上使用的安全性和可行性，为聚明胶肽的临床应用提供实验依据。 方法：选择14例健康杂种犬，随机分为两组，聚明胶肽注射液急性等容血液稀释组（Ⅰ组，n=7）和HAES急性等容血液稀释组（Ⅱ组，n=7）。两组均在麻醉后行气管内插管，接动物呼吸机行机械通气，接心电图机监测心电图（ECG）和心率（HR），经左颈外静脉置入5F Swan-Ganz漂浮导管，测定中心静脉压（CVP）、平均肺动脉压（MPAP）、肺动脉楔嵌压（PAWP）及心输出量（CO），并计算出心脏指数（CI），体循环阻力指数（TVRI）和肺循环阻力指数（PVRI）等各血流动力学指标，股动脉置管测直接平均动脉压（MAP），股静脉置管。 经股动脉放血，同时以相同速率经股静脉输入等量聚明胶肽（Ⅰ组）和HAES（Ⅱ组），直至血Hct达30％，即中度血液稀释水平。记录血液稀释前及血液稀释后10′、30′、60′、90′、120′各项血流动力学指标，并且在血液稀释前、血液稀释稀释后0′、60′、120′抽取股静脉检测血液流变学指标血电解质和凝血功能等指标，并抽取股动脉和肺动脉血进行血气分析。 结果：两组动物在血液稀释后HR、MAP、MPAP、PAWP、CVP均无明显变化（P＞0.05），CO和CI值在血液稀释后上升明显。体循环阻力指数（TVRI）和肺循环阻力指数（PVRI）在稀释后有所下降。全血粘度下降显著（P＜0.05）。两组动物动脉血乳酸盐值在血液稀释后有轻度下降，但不明显（P＞0.05），动脉血pH值、动脉氧分压（PaO₂）、动脉血氧饱和度（SaO₂）均无显著变化（P＞0.05），纤维蛋白原（FIB）值均有轻度下降，但无显著性（P＞0.05），PT和APTT值均无明显变化（P＞0.05），血小板计数（PLT）均下降明显（P＜0.05）。血电解质各指标变化均无统计学意义（P＞0.05）。两组组间比较各指标差异无显著性（P>0.05）。 结论:聚明胶肤注射液进行中度的急性等容血液稀释血流动力学稳定，可增加心输出量，降低体循环和肺循环阻力，并且降低血液粘度，有利于组织血流灌注，保证氧供，对凝血功能和电解质影响较小，和目前常用的其他类型血浆代用品效果相当，认为可安全有效地应用于临床。更多还原

【Abstract】 Objective: The study is to observe the effects of acute normovolemic hemodilution with 5% Polygelatine Injection comparing with 6% hydroxyethyl starch (HAES) on, hemodynamics ,Hemorheology ,coagulation ,oxygen transport and consumption,blood gas and lactic acid in anesthesized dogs.Methods: Fourteenth healthy dogs of either sex,weighting 12-16kg,were randomly divided into two groups:5% polygelatine injection group( I), n=7 and 6% hydroxyethyl starch (HAES) group(II), n=7. The dogs were anesthesized initially with pentobarbital sodium 30 mg kg-1 administered intravenously.Intraoperative monitoring included continuous monitoring of lead II and V5 of the electrocardiogram and automated ST-segment analysis. Femoral artery was cannulated for infra-arterial blood pressure monitoring and blood gas analysis, Femoral vein was cannulated for blood sampling and infusion.Swan-ganz catheter was inserted though right external jugular vein for monitoring heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), pulmonary artery pressure(PAP),pulmonary arterial wedged pressure(PAWP), cardiac index (CI), systemic vascular resistance index (TVRI), pulmonary vascular resistance index(PVRI) and coronary perfusion pressure (CPP) throughout experiment. Arterial and central venous blood samples were taken for blood gas analysis and determination of lactic acid concentration before and after AHN. At preANH and postANH, arterial and mixed venous blood gases were obtained, for calculating oxygen consumption (VO2) and oxygen extraction rate (OER).All dogs underwent moderate hemodilution to a target Hct was of 30%. 5% Polygelatine injection and 6% hydroxyethyl starch (HAES) were administered in a 1:1 volume replacement ratio. The two groups received a maximum of 20 ml/kg of the studyfluid during hemodilution.Data was expresed as mean SD and analyzed using SPSS for Windows software (release 11.5, SPSS Institute, Chicago, IL). Changes in variables measured before and during hemodilution and recovery were analyzed statistically in each group using the Student paired t test. Differences between the two groups were also analyzed using the Student paired t test. P values <0.05 were considered statistically significant.Results: 1 ANH was well tolerated hemodynamically in two groups. Heart rate remained unchanged, or decreased slightly, whereas CI remained stable in all portions of the investigation. Mean arterial pressure do not decreased at postANH in the 5% polygelatine injection group and 6% hydroxyethyl starch (HAES) group . Systemic vascular resistance did not change significantly in both of the groups. There were no significant differences between groups at any hemodynamic data point. 2, Oxygen consumption remained stable throughout the study.Electrolytes ,pH ,PaO2 and lactate were kept stable throughout operation. None of the dogs became acidotic during the hemodilution process. ST segment changes were not observed in any dogs during or after completion of ANH in our study. 3, Blood low,middle and high shear rate viscosity after ANH were obviously lower than that before ANH. 4, Our study did not show significant degradation of coagulation capacity as indicated by PT and APTT.Conclusion Polygelation injection can be used safely for ANH in terms of hemodynamic changes and oxygen transport and consumption.更多还原