【摘要】 目的:探讨应用6%羟乙基淀粉行急性高容量血液稀释(AHH)对老年患者动脉压和氧代谢的影响。方法:随机选择腹部择期手术的老年患者40例,随机分为两组,A组为高容量血液稀释组,B组为非血液稀释组。B组入室后补充基础生理需要量及禁食丧失需要量。A组患者以25m l/m in的速率输入6%羟乙基淀粉7m l/kg后诱导,同时继续输入达15m l/kg行高容量血液稀释,分别监测记录基础值(T0)、诱导后插管前(T1)、插管后即刻(T2)、插管后5m in(T3)、10m in(T4)、20m in(T5)、切皮前(T6)的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)。经桡动脉取血测血气、Lac。结果:A组患者诱导前后MAP无显著性差异(P>0.05),B组诱导后MAP显著降低(P<0.05),与同时相A组比较有显著性差异(P<0.05)。A组CVP插管后5m in(T3)与基础值(T0)比较有显著性差异(P<0.05),与同时相B组比较有显著性差异(P<0.05),两组患者HR诱导后减慢(P<0.05)。A组血红蛋白(Hb)、细胞压积(Hct)在血液稀释后显著降低(P<0.05)。两组血气、Lac在血液稀释前后无显著性变化(P>0.05)。结论:适度AHH有利于维持老年患者血液动力学的稳定,而氧代谢改变不明显,值得临床推广。更多还原

【Abstract】 Objective: To explore the effect of acute hypervolemic hemodilution by using 6% hydroxyethyl starch on arterial pressure and oxygen metabolism in aged patients.Methods: Forty patients receiving timing-selective abdominal surgery were randomly divided into 2 groups,hypervolemic hemodilution group(Group A) and non-hypervolemic hemodilution group(Group B).Patients in Group A were given general transfusion for supplying basic required volume in physiology and lost volume due to fasting,patients in group B were infused 6% hydroxyethyl starch in 7ml/kg by velocity of 25ml/min to induce and hydroxyethyl starch was continually infused to 15ml/kg to make hypervolemic hemodilution.MAAP,HR and CVP were monitored and recorded before induction of anesthesia(T0,baseline); before tracheal intubation(T1);after tracheal intubation immediately(T2);5,10 and 20 min.after intubation(T3,T4,T5) and before skin incision(T6).Blood gas and Lac were determined at the time points mentioned.Results: No significant difference of MAP was found before and after induction in Group A(P>0.05);MAP was significantly lower after induction in Group B(P<0.05) and there was significant difference in the comparison of MAP between the two groups(P<0.05);CVP in group A at T3 was significantly different from which at T0(P<0.05) and there was significant difference in the comparison with group B(P<0.05).HR was significantly lower after induction in two groups(P<0.05).Hb and Hct in group A were lower after hemodilution.No significant difference was seen in the comparison of blood gas and Lac between the two groups before and after hemodilution(P>0.05).Conclusion: Moderate AHH was beneficial to maintaining the stability of hemodynatics and there is no much change in oxygen metabolism.更多还原