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胃肠道手术全麻诱导期急性高容量血液稀释的液体选择

The choice of different kinds of fluid for acute hypervolemic hemodilution in patients undergoing gastrointestinal operation during induction of general anesthesia
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摘要 目的:观察胃肠道手术全麻诱导期行急性高容量血液稀释(AHH)的液体选择。方法:选择胃肠道手术病人20例,随机分为A组(万汶组)和B组(勃脉力A组)各10例。A组:入室后20min内输入万汶7ml·kg-1后诱导,继续输入万汶达15ml·kg-1行AHH;B组:同样方法输入勃脉力A(醋酸钠林格氏液)。分别记录基础值(T0),诱导后插管前(T1)、插管后即刻(T2)、插管后5min(T3)、插管后10min(T4)、插管后20min(T5)、切皮前(T6)的MAP、HR、CVP;于AHH前(t0)、AHH后即刻(t1),AHH后1h(t2)分别经桡动脉、锁骨下静脉抽血测血气、乳酸、电解质。计算动脉血氧含量(CaO2)、中心静脉血氧含量(CcvO2)、氧摄取率(ERO2)、扩容率。结果:A、B两组血流动力学变化无差异。扩容率A组>B组。pH值B组t1时高于正常值,t2时恢复正常。两组HCO3-在AHH前后无差异,乳酸在t2时均升高,PCO2B组t1时降低。CaO2、CcvO2:A组t1、t2较t0降低;B组t1降低,t2升至t0水平。ERO2:A组组内无差异,B组t1、t2较t0升高。Na+、K+、BUN:A、B两组AHH前后无差异。Cl-:A组AHH前后无差异;B组t1较t0降低,t2升至t0水平。Glu两组变化趋势相同:t0、t1无差异,t2较t1升高。结论:晶体液和胶体液扩容预防全麻诱导期低血压效果无明显差别,用于诱导期扩容安全有效。勃脉力A对稳定机体生理内环境更具优越性,而万汶扩容作用及维持时间优于勃脉力A。 Objective :To investigate the choice for different Kinds of fluid for acute hypervoternic hemodltution in patients undergoing gastrointestinal operation during Induction of general anesthesia. Methods :Twenty(ASA Ⅰ-Ⅱ ) patients without cardiac and pulmonary disease of both sexes aged 22-65 years undergoing elective gastrointestinal surgery were randomly divided Into two groups:Votuven group(group A,,= 10)and Plasrnalyte A group(group B, n= 10). Radial artery and right subolavlan vein were cannulated under local infiltration for BP and CVP monltoring.EOG,SpO2 and HR were continuously monitored during anesthesia. Anesthesia was Induced with mldazolam 0.05mg · kg^-1 ,fentanyl 3μg · kg^-1 ,propofol 1.5-2.0 mg· kg^-1 and veouronium 0. 1 mg · kg^-1 . After tracheal Intubation the patients were mechanically ventilated. VT and FR were respeotlvely set at 10 ml ·kg^-1 and 12 f · min ^-1 . Anesthesia was maintained with isoflurane and intermittent i. v. closes of fentanyl and vecuronlum. Patients of group A received Voluven (Hydroxyethyl Starch 130/0.4 and sodium Chloride Injection) 7ml ·kg^-1 in 20 min before Induction and 8 ml · kg^-1 after Induction. Patients of group B recelvecl Plasmalyte A(Multlple Electrolytes InJection) as the method of group A, Arterial and venous blood samples were taken for blood analysis and deteminnation of lactic acid, elect rolyte, Hb and Hct before AHH(t0 ), the moment after AHH(t1 ) 1 h after AHH(t2 ). Arterial Oxygen Content( CaO2 ), Central Venous Oxygen Content (CcvO2), Oxygen Extraction Retlo(ERO2 )and Volume Expansion Rate were calculated. Results: 1. There were no significantly differenoes of hemoaynamics between group A and group B. 2. Volume Expansion Rate:A〉B,Hb and Hot significantly Increased in group B at t2.3. PH inoreased In group B at t1 ,furthermore exceeded the normal value, but gradually returned to the baseline at t2 ; BE slightly increased at t1 within the normal value; HCO3^- unchanged before a
作者 程显玲 李刚
出处 《中国现代普通外科进展》 CAS 2006年第6期368-370,372,共4页 Chinese Journal of Current Advances in General Surgery
关键词 麻醉 全身·血液稀释 血流动力学·万汶·勃脉力A Anesthesia,general · Hemofiltration · Haemodynamics · Voluven · Plasmalyte A
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参考文献6

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