摘要
目的探讨术前以6％中分子羟乙基淀粉（130／0．4，万汶）行急性超容血液稀释（AHHD）在肝肿瘤手术患者中的安全性。方法30例ASAI-Ⅱ级的肝肿瘤患者，随机分为AHHD组（15例）和对照组（15例）。AHHD组全麻插管后在20—30min内输入万汶15ml／kg。对照组仅常规输入乳酸林格液[6—8ml／（kg·h）]。术中连续监测心率（HR）、平均气道压（MAP）、中心静脉压（CVP）、血氧饱和度（SpO2）、呼气末二氧化碳分压（P^ET，CO2）。术毕记录输液量、失血量和输血量。在AHHD前、AHHD后15min、手术结束时和术后第1天，各时点抽取动、静脉血液样本行血气分析、血常规和凝血功能检测。结果两组组间比较，输入异体血例数差异有统计学意义（P〈0．05）；AHHD组血液稀释后CVP显著高于血液稀释前（P〈0．01）；AHHD组红细胞压积（Hct）在血液稀释后显著降低（P〈0．05）。结论肝肿瘤手术患者术前用万汶行AHHD是安全、有效的，能有效地减少手术期间异体输血的机会和数量。
Objective To investigate the feasibility of application of preoperative acute hypervolemic hemodilution （AHHD） with 6% HES 130/0.4 in patients undergoing hepatic tumor operation. Methods Thirty ASA class I - II patients undergoing elective hepatic tumor operation under general anesthesia and epidural anesthesia were randomized to AHHD group and control group. After tracheal intubation, the patients in AHHD group were infused 6% HES 130/0.4 15 mb/kg in 20 -30 minutes, and the patients in control group were infused routinely lactated Ringer＇s solution. In both groups, HR, MAP, CVP, SpO2 and PrrCO2 were monitored during the whole anesthetic procedures. The volume of infusion, blood loss and blood transfusion were recorded during the operation. Blood samples were collected for measuring Hct, blood biochemical indices, PT and APTY before and 15 minutes after hemodication, at the end of operation and the first day of postoperation. Results As compared with control group, there was no significant change in blood loss （P 〉 0.05 ） in AHHD group. There were 4 patients in AHHD and 8 patients in control group required homologous blood transfusion, （P 〈 0.05 ）. There were no significant changes （P 〉 0.05 ） in HR and MAP in two groups, but the level of CVP increased and Hct decreased af- ter hemolution in AHHD group （P 〈 0.01 or P 〈 0.05 ）. Conclusion Acute hypervolemic hemodilution with HES 130/0.4 infusion provides an effective protection for patients undergoing hepatic tumor operation. It plays an important role in avoiding unnecessary blood transfusion.
出处
《中国医师进修杂志（外科版）》
2006年第9期19-21,共3页
Chinese Journal of Postgraduates of Medicine
