CAJ | 학술논문

目的观察不同血浆代用品术前急性高容量血液稀释(AHH)对神经外科手术患者血气分析及电解质的影响.方法将60例ASA分级Ⅰ～Ⅱ级患者随机分成三组:羟乙基淀粉组(V组)、聚明胶肽组(P组)和平衡液组(R组),每组各20例.麻醉诱导后分别在30min内输入6%羟乙基淀粉、5%聚明胶肽和平衡液(乳酸林格液)20 ml/kg.于AHH前(T1)、AHH完成即刻(T2)和AHH后30min(L)采动脉血1 ml立即测定血气分析、红细胞压积(Hct)、Hb及电解质.每10min记录HR、平均动脉压(MAP)和中心静脉压(CVP).结果扩容率R组低于P组和V组(P＜0.05).V组和P组的CVP在T2和T2分别为[分别为(15.1±3.6)、(14.3±3.4)cm H2O(1 cm H2O=0.098 kPa)和(16.8±3.3)、(14.9±3.8)cm H2O]较T1[分别为(8.1±1.9)、(8.2 ±1.9)cm H2O]升高(P＜0.01).与T1比较,P组K+在T3升高,v组Na+在T2升高,V组Ca2+在T1降低;与T2比较,V组、P组K+在T3升高;与P组比较,V组K+在T2降低,Ca2+在T3降低,但都在正常范围.结论羟乙基淀粉和聚明胶肽扩充血容量效果好,优于平衡液,血流动力学稳定;羟乙基淀粉、聚明胶肽对血气分析和电解质效果影响小,可安全使用于神经外科手术患者.
목적 관찰불동혈장대용품술전급성고용량혈액희석(AHH)대신경외과수술환자혈기분석급전해질적영향.방법 장60례ASA분급Ⅰ～Ⅱ급환자수궤분성삼조:간을기정분조(V조)、취명효태조(P조)화평형액조(R조),매조각20례.마취유도후분별재30min내수입6%간을기정분、5%취명효태화평형액(유산림격액)20 ml/kg.우AHH전(T1)、AHH완성즉각(T2)화AHH후30min(L)채동맥혈1 ml립즉측정혈기분석、홍세포압적(Hct)、Hb급전해질.매10min기록HR、평균동맥압(MAP)화중심정맥압(CVP).결과 확용솔R조저우P조화V조(P＜0.05).V조화P조적CVP재T2화T2분별위[분별위(15.1±3.6)、(14.3±3.4)cm H2O(1 cm H2O=0.098 kPa)화(16.8±3.3)、(14.9±3.8)cm H2O]교T1[분별위(8.1±1.9)、(8.2 ±1.9)cm H2O]승고(P＜0.01).여T1비교,P조K+재T3승고,v조Na+재T2승고,V조Ca2+재T1강저;여T2비교,V조、P조K+재T3승고;여P조비교,V조K+재T2강저,Ca2+재T3강저,단도재정상범위.결론 간을기정분화취명효태확충혈용량효과호,우우평형액,혈류동역학은정;간을기정분、취명효태대혈기분석화전해질효과영향소,가안전사용우신경외과수술환자.
Objective To observe the effects of acute hypervolemic hemodilution(AHH)with dif-ferent plasma substitutes on blood gas analysis and plasma electrolytes in neurosurgieal patients.Methods Sixty ASA Ⅰ-Ⅱpatients undergoing elective neurosurgery were divided into 3 groups(n=20 each)：voluven group(group V),polygeline group(group P)and lactated Ringer solution group(group R).After in-duetion of anesthesia the patients were randomized to receive 20 ml/kg of either 6% voluven,5% polygeline or lactated Ringer solution within 30 min.Blood samples were taken before(T1),immediately(T2)and 30 min after the end fluid infusion(T3)for determination of blood gas analysis including Hct and Hb,the plas-ma electrolytes.And during the hemodilution the heart rate(HR),mean arterial pressure(MAP) and central venous pressure(CVP) were continuously monitored.Results Group R was significantly lower in fluid ex-pansion rate than group P and group V,but there was no significant difference between group P.In the HH procedure three groups of patients MAP and HR maintained stable relatively,CVP increased signifieantly af-ter AHH compared with the baseline value before AHH in group V and group P(P<0.01).Compared with T1,plasma potasgium concentration significantly increased in group P in T3 and plasma sodium concentra-tion signitieantly increased in group V in T2(P<0.01),while plasma calcium concentration significantly de-creased in group V in T2(P<0.05).Compared with T2,plasma potassium oncentration signitleantly in-creased in group V and group P in T3(P<0.05 or 0.01).Compared with group P,plasma potassium con-centration decreased in group V in T2,while plasma calcium concentration significantly decreased in group V in T3(P<0.05).but they were still within normal range.Conclusions Voluven and polygeline are compa-rable in expanding blood volume and more efficient than lactated Ringer solution,hemodynamics is stable.Voluven and polygeline are small influence to the blood gas analysis and plasma electndytes,and safety han-dling in neurosurgical pafients.