国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2009年
4期
303-305,323
,共4页
容量调控%高容量血液稀释%活体肾移植%氧代谢
容量調控%高容量血液稀釋%活體腎移植%氧代謝
용량조공%고용량혈액희석%활체신이식%양대사
Capacity control%Hypervolemic hemodilution%Living renal transplantation%Oxygen metabolism
目的 观察高容量血液稀释联合硝酸甘油容量调控对活体肾移植供肾者全身氧代谢的影响.方法 选择在全麻腹腔镜下行肾脏切除术的健康志愿捐肾者12例,诱导前15 min至肾动脉阻断时连续输注预设量4%琥珀酰明胶及乳酸林格氏液行高容量血液稀释,目标稀释值红细胞压积(Hct)为25%;同时微量泵输注硝酸甘油,维持平均动脉压(MAP)在基础值±25%范围内.分别于入室时(T0)、气腹时(T1)、肾动脉阻断前15min(T2)肾动脉阻断时(T3)、阻断后30min(T4)、60min(T5)测定并记录Hct、心输出量(CO)、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)、血乳酸(Lac)、中心静脉血氧饱和度(ScvO2)和胃黏膜内pH值(ipH)、胃黏膜内动脉血二氧化碳分压(PgCO2)、胃黏膜内动脉血二氧化碳分压与动脉血二氧化碳分压差(Pg-aCO2)的变化.结果 高容量血液稀释及硝酸甘油容量调控后,Hct从42.7%±1.9%下降到25.7%±1.1%(P＜0.05);CVP值逐渐升高,与基础值比较差异有统计学意义(P＜0.05);DO2、CO在T1有所下降,T2-4则均高于T1,T3与T1比较差异有统计学意义(P＜0.05);各时点VO2均下降,但各时点差异无统计学意义(P＞0.05);ScvO2有下降趋势,ERO2、Lac有上升趋势,但各时点差异均无统计学意义(P＞0.05);ipH有所下降,PgCO2于T1后有所升高,T3与T0比较差异有统计学意义(P＜0.05).结论 腹腔镜活体肾移植供体肾切除术中实施容量调控,供肾灌注良好,供肾者全身氧代谢稳定、内脏氧合良好,未见明显无氧代谢.
目的 觀察高容量血液稀釋聯閤硝痠甘油容量調控對活體腎移植供腎者全身氧代謝的影響.方法 選擇在全痳腹腔鏡下行腎髒切除術的健康誌願捐腎者12例,誘導前15 min至腎動脈阻斷時連續輸註預設量4%琥珀酰明膠及乳痠林格氏液行高容量血液稀釋,目標稀釋值紅細胞壓積(Hct)為25%;同時微量泵輸註硝痠甘油,維持平均動脈壓(MAP)在基礎值±25%範圍內.分彆于入室時(T0)、氣腹時(T1)、腎動脈阻斷前15min(T2)腎動脈阻斷時(T3)、阻斷後30min(T4)、60min(T5)測定併記錄Hct、心輸齣量(CO)、氧供(DO2)、氧耗(VO2)、氧攝取率(ERO2)、血乳痠(Lac)、中心靜脈血氧飽和度(ScvO2)和胃黏膜內pH值(ipH)、胃黏膜內動脈血二氧化碳分壓(PgCO2)、胃黏膜內動脈血二氧化碳分壓與動脈血二氧化碳分壓差(Pg-aCO2)的變化.結果 高容量血液稀釋及硝痠甘油容量調控後,Hct從42.7%±1.9%下降到25.7%±1.1%(P＜0.05);CVP值逐漸升高,與基礎值比較差異有統計學意義(P＜0.05);DO2、CO在T1有所下降,T2-4則均高于T1,T3與T1比較差異有統計學意義(P＜0.05);各時點VO2均下降,但各時點差異無統計學意義(P＞0.05);ScvO2有下降趨勢,ERO2、Lac有上升趨勢,但各時點差異均無統計學意義(P＞0.05);ipH有所下降,PgCO2于T1後有所升高,T3與T0比較差異有統計學意義(P＜0.05).結論 腹腔鏡活體腎移植供體腎切除術中實施容量調控,供腎灌註良好,供腎者全身氧代謝穩定、內髒氧閤良好,未見明顯無氧代謝.
목적 관찰고용량혈액희석연합초산감유용량조공대활체신이식공신자전신양대사적영향.방법 선택재전마복강경하행신장절제술적건강지원연신자12례,유도전15 min지신동맥조단시련속수주예설량4%호박선명효급유산림격씨액행고용량혈액희석,목표희석치홍세포압적(Hct)위25%;동시미량빙수주초산감유,유지평균동맥압(MAP)재기출치±25%범위내.분별우입실시(T0)、기복시(T1)、신동맥조단전15min(T2)신동맥조단시(T3)、조단후30min(T4)、60min(T5)측정병기록Hct、심수출량(CO)、양공(DO2)、양모(VO2)、양섭취솔(ERO2)、혈유산(Lac)、중심정맥혈양포화도(ScvO2)화위점막내pH치(ipH)、위점막내동맥혈이양화탄분압(PgCO2)、위점막내동맥혈이양화탄분압여동맥혈이양화탄분압차(Pg-aCO2)적변화.결과 고용량혈액희석급초산감유용량조공후,Hct종42.7%±1.9%하강도25.7%±1.1%(P＜0.05);CVP치축점승고,여기출치비교차이유통계학의의(P＜0.05);DO2、CO재T1유소하강,T2-4칙균고우T1,T3여T1비교차이유통계학의의(P＜0.05);각시점VO2균하강,단각시점차이무통계학의의(P＞0.05);ScvO2유하강추세,ERO2、Lac유상승추세,단각시점차이균무통계학의의(P＞0.05);ipH유소하강,PgCO2우T1후유소승고,T3여T0비교차이유통계학의의(P＜0.05).결론 복강경활체신이식공체신절제술중실시용량조공,공신관주량호,공신자전신양대사은정、내장양합량호,미견명현무양대사.
Objective To investigate the effects of capacity control on oxygen metabolism of donors in living renal transplantation using laparoscopy.Methods Hypervolemic hemodilution (HHD) was performed with continuous infusion of 4% suceinylated.gelatin(SG) and lactated Ringer's solution(RL) from 15 min before anesthesia induction to renal artery interruption to decrease Hct to the level of 25% in 12 healthy donors for living renal transplantation.Meanwhile,micro-pump infusion of nitroglycerin was administered to maintain MAP change within the range of ± 25% of base value.Hct,CO,DO2,VO2,ERO2,Lac,SevO2,ipH,PgCO2,Pg-aCO2 were recorded or measured before anesthesia (T0),at the beginning of aeroperitonia (T1),15 min before renal artery interruption(T2),at the start of renal artery interruption(T3),30 min(T4) and 60 min(T5) after renal artery interruption.Results After hypervolemic hemodilution and control hypotension with nitroglycerin,Hct went down from (42.7± 1.9) % to (25.7 ±1.1) %,and CVP increased gradually(P＜0.05).DO2 and CO decreased at T1,and increased later,with significance between T3 and T1 (P＜0.05).There was no significant difference in VO2,ScvO2,ERO2 and Lac among time-points,ipH decreased slightly and PgCO2 increased after T1,reaching a significant level at T3 (P＜0.05).Conclusion Implementation of capacity control improves donor's renal perfusion,maintains a stable oxygen metabolism with more efficient organ oxygenation,without anaerobic metabolism.
