CAJ | 학술논문

目的评价应用不同液体行急性高容量血液稀释(AHH)对老年食管癌根治术患者血流动力学、凝血功能的影响.方法择期全身麻醉复合硬膜外食管癌手术患者90例,完全随机分为3组:每组30例,麻醉诱导前30 min,A组按15～20 ml/kg,以20 ml/min速率静脉滴注6%羟乙基淀粉(200/0.5);B组以同样的剂量、速率静脉滴注6%羟乙基淀粉(130/0.4);C组静脉滴注乳酸钠林格液.分别记录AHH前(t_1)、插管即刻(t_2)、插管后10 min(t_3)、AHH后10 min(t_4)、手术3 h(t_5)、手术结束(t_6)的MAP、CVP、HR和各时间点的Hb、Hot、Plt、PT、APTF及FIB的变化.结果血流动力学:组内与AHH前(t_1)比较,A、B组在t_4、t_5时点CVP、MAP显著升高,差异均有统计学意义;Hct显著下降;A、B组在t_4、t_5与C组比较,CVP、MAP升高,Hct下降,差异均有统计学意义(P<0.05).凝血功能变化:组内与t_1相比,A、B组Plt在t_3、t_4、t_5时点显著下降;C组尤明显变化;PT、APTT明显延长,FIB亦明显下降,而C组仅在t_5时点延长或下降,差异均有统计学意义(均P<0.05);A、B组在t_4、t_5与C组比较差异均有统计学意义(均P<0.05).而A、B组之间血流动力学与凝血功能差异均无统计学意义.C组术中输液、输血量显著高于A、B组(t分别为2.99、24.63、3.58、24.20,均P<0.01).结论 6%羟乙基淀粉(200/0.5)和6%羟乙基淀粉(130/0.4),AHH对老年食管癌手术循环稳定、凝血功能抑制轻,减少输血量,节约血源.
목적 평개응용불동액체행급성고용량혈액희석(AHH)대노년식관암근치술환자혈류동역학、응혈공능적영향.방법 택기전신마취복합경막외식관암수술환자90례,완전수궤분위3조:매조30례,마취유도전30 min,A조안15～20 ml/kg,이20 ml/min속솔정맥적주6%간을기정분(200/0.5);B조이동양적제량、속솔정맥적주6%간을기정분(130/0.4);C조정맥적주유산납림격액.분별기록AHH전(t_1)、삽관즉각(t_2)、삽관후10 min(t_3)、AHH후10 min(t_4)、수술3 h(t_5)、수술결속(t_6)적MAP、CVP、HR화각시간점적Hb、Hot、Plt、PT、APTF급FIB적변화.결과 혈류동역학:조내여AHH전(t_1)비교,A、B조재t_4、t_5시점CVP、MAP현저승고,차이균유통계학의의;Hct현저하강;A、B조재t_4、t_5여C조비교,CVP、MAP승고,Hct하강,차이균유통계학의의(P<0.05).응혈공능변화:조내여t_1상비,A、B조Plt재t_3、t_4、t_5시점현저하강;C조우명현변화;PT、APTT명현연장,FIB역명현하강,이C조부재t_5시점연장혹하강,차이균유통계학의의(균P<0.05);A、B조재t_4、t_5여C조비교차이균유통계학의의(균P<0.05).이A、B조지간혈류동역학여응혈공능차이균무통계학의의.C조술중수액、수혈량현저고우A、B조(t분별위2.99、24.63、3.58、24.20,균P<0.01).결론 6%간을기정분(200/0.5)화6%간을기정분(130/0.4),AHH대노년식관암수술순배은정、응혈공능억제경,감소수혈량,절약혈원.
Objective To evaluate the influence of acute hypervolemic hemodilution (AHH) on hemody-namic and coagulation status of elderly patients with radical resection of esophageal carcinoma. Methods Ninety patients aged 60～89 years undergoing elective esophageal carcinoma surgery under general anesthesia combined with epidural analgesia were randomly divided into 3 groups (n = 30). 30 minutes before anesthesia, group A was given 6% HES(200/0.5) 15～20 ml/kg, 20 ml/min; group B was given 6% VOLUVEN(HES 130/0.4); group C was given sodium lactate Ringer's solution. Mean arterial pressure (MAP), central vein pressure (CVP) and heart rate (HR) were recorded before AHH(t_1), at intubation(t_2), 10 minutes after intubation(t_3), 10 minutes after AHH(t_4), 3 hours after operation began(t_5) and at the end of operation (t_6). Changes of H6, Hct, PLT, PT, APTT and FIB were recorded. Result The levels of CVP, MAP increased (P < 0.05) in group A and B, and Hct decreased. As for coagulation function, PT, APTT, FIB either prolonged or decreased (P<0.05) at t_1; at t_3 and t_4, PCT decreased obviously(P < 0.01). There was not significant difference of hemodynamic and coagulation be-tween Group A and B. (P > 0.05). Volume of liquid and blood transfusion during operation in Croup C was higher than that in Group A and B. Conclusion AHH can effectively maintain hemodynamic stability and reduce blood transfusion.