【作者】 张冬梅； 郎淑慧； 徐向辉； 朱立宏； 常业恬；

【Author】 ZHANG Dong-mei~1,LANG Shu-hui~1,XU Xiang-hui~2,ZHU Li-hong~1,CHANG Ye-tian~2 (1.Department of Anesthesia,Affiliated Hospital of Ningxia Medical University,Yinchuan 750004,China;2.Department of Anesthesiology,Second Xiangya Hospital of Central South University, Changsha 410011,China

【机构】 宁夏医科大学附属医院麻醉科； 中南大学湘雅二医院麻醉科；

【摘要】 目的探讨术前急性高容血液稀释（AHH）联合尼卡地平降压对老年患者血液动力学和氧代谢的影响。方法择期行肝胆肿瘤切除手术患者30例,心功能Ⅰ～Ⅱ级,年龄（60-76岁）,随机分为术前AHH联合尼卡地平降压组（AHHN组n=15）和对照组（n=15）。于术前1h分段实施AHH,使红细胞压积（Hct）下降至28.1%,以达到中等程度血液稀释状态。术中连续监测MAP、HR、Sp02、CVP,分别于血液稀释前（T0）、稀释后15min（T1）、术毕（T2）采集动静脉血行血气分析,测定血红蛋白（Hb）、Hct,动脉血乳酸（ABL）,并计算动脉血氧含量（CaO₂）、混合静脉血氧含量（CvO₂）和氧摄取率（ERO₂）,记录输血量、输液量和失血量。结果两组患者平均动脉/压MAP和心率HR在稀释前后波动在正常范围内,T1时在AHHN组CVP明显升高（P<0.05）,但组间比较差异均无统计学意义（P<0.05）;Hb、Hct在各时点均显著降低（P<0.05或P<0.01）,T1时点组间比较差异有统计学意义（P<0.05或P<0.01）。两组患者扩容前CaO₂、CvO₂和ERO₂差异均无统计学意义（P>0.05）,随着血液的稀释,AHHN组CaO₂和CvO₂逐渐降低,C（a-v）O₂也降低,而ERO₂呈增高趋势,所有病人的ABL值均无明显变化,（a-v）O₂和ERO₂及ABL组间比较差异无统计学意义（P>0.05）。结论老年患者分段实施术前AHH联合尼卡地平降压,能维持血液动力学的稳定,对机体的氧代谢无明显影响,是安全可行的。更多还原

【Abstract】 Objective To investigate effects of acute hypervolemic hemodilution（AH H） combined with controlled hypotension（CH） on circulatory functio and oxygen metabolism of the elderly patients. Methods:Thirty ASAⅠ～Ⅱpatients（60-76yr） scheduled for elective hepatic and gall tumor operation were randomly divided into two groups:AHH+nicardipine（groupAHHN）and control group,each group containing 15 case.AHH was induced with 6%HES at 25 ml min^-1 before induction and before skin incision.Hct was decreased to 28.1%.MAP、HR、SpO₂、CVP were continuously monitored throughout operation.Arterial and central venous blood samples were taken for gas analysis and determination of Hb,Hct and arterial blood lactate（ABL） before（T0） and 15min after AHH（T1）,and at the end of the surgery（T2）.Arterial oxygen content（CaO₂）,mixedvenous oxygen saturation（SvO₂）,oxygen extraction rate（ERO₂） were calculated.The volume of infusion,blood loss and blood transfusion were recorded during the operation.Results:There were no significant changs in MAPand HR after AHH and during operation（P>0.05）.CVP at T1 was higher than T0 in group AHHN（P<0.05）,but within normal range.Hb and Hct decreased gradually after AHH（P<0.05）,there were significant change at T1 between groups（P<0.05 or P<0.01）.CaO₂ and SvO2 were decreased significantly,but ERO₂ increased significant ly,ABL was not changed after AHH.There were not significantly different in（a-v）O₂、ERO₂ and ABL between gorups.Conclusion:AHH combined with controlled hypotension induced with nicardipine can effectively and safely maintain a stable hemodynamic status in aged patients,there was not effectely to oxygen metabolism.更多还原