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
2012年
10期
664-667
,共4页
陈燃%刘学胜%鲁显福%顾尔伟
陳燃%劉學勝%魯顯福%顧爾偉
진연%류학성%로현복%고이위
非体外循环冠状动脉旁路移植术%急性超容量液体填充%血液动力学
非體外循環冠狀動脈徬路移植術%急性超容量液體填充%血液動力學
비체외순배관상동맥방로이식술%급성초용량액체전충%혈액동역학
Off-pump coronary artery bypass grafting%Acute hypervolemic fluid infusion%Hemodynamics
目的 研究全麻诱导期急性超容量液体填充(acute hypervolemic fluid infusion,AHFI)对冠状动脉粥样硬化性心脏病患者行非体外循环冠脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)血液动力学的影响.方法 40例患者按随机数字表法随机分为6％羟乙基淀粉130/0.4 (6％ hydroxyethyl starch 130/0.4,HES 130/0.4)组和乳酸林格液(lactated ringer's solution,RL)组,每组20例.全麻诱导前5 min开始,30 min内分别输注HES 130/0.4或RL10 ml/kg.在麻醉诱导前5min(T0),诱导后即刻(T1),插管后即刻(T2),插管后5 min(T3)及AHFI结束后(T4)分别记录心率(HR),血压(BP),中心静脉压(central venous pressure,CVP),心脏指数(cardiac index,CI),每搏输出量(stroke volume,SV)及每搏变异指数(stroke volume variation,SVV). 结果 与T0时HR[(66.2±9.5)次/min、平均动脉压(mean arterial pressure,MAP)[(98.6±12.5) mm Hg(1 mm Hg=0.133 kPa)]、CI[(2.7±0.4)L·min-1·m-2]、SV [(82.5±17.4) ml]及SVV[(8.6±4.3)％]比较,HES130/0.4组患者T1时MAP[(82.3±10.8) mm Hg]、CI[(2.3±0.3)L·min-1·m-2]及SV [(73.4±15.5) nl]均下降；在T3和T4时HR[(57.8±6.2)次/min和(56.4±6.9)次/min ]下降；T4时CI[(3.2±0.4)L·min-1· m-2]升高,但是SVV[(6.3±3.2)％]降低(P＜0.05)；而RL对照组在T1、T3及T4时MAP[ (78.8±12.1) 、(82.7±12.9)、(79.2±10.1) mm Hg]和SV[(71.3±16.2)、(73.6±15.9)、(74.4±16.3)ml]均降低(P＜0.05或P＜0.01).在T3时与RL对照组CI[(2.5±0.4)L·min-1·m-2]和SV[( 73.6± 15.9) ml]比较,HES 130/0.4组CI[(3.0±0.5)L·min-1·m-2]和SV [(91.2±18.6) ml]均升高(P＜0.05).在T4时与RL对照组MAP[ (79.2±10.1) mm Hg] 、CI[(2.6±0.4)L·min-1· m-2] 、SV[ (74.4±16.3) ml]和SVV[(10.6±4.5)％)]比较,HES130/0.4组MAP[(88.2±9.4)mm Hg]、CI[(3.2±0.4)L·min-1·m-2]和SV[(91.2±18.6)％]均升高,但SVV[(6.3±3.2)％]明显降低(P＜0.05).结论 OPCABG全麻诱导期行AHFI安全有效,使用HES130/0.4比RL能更好地维持全麻诱导期间的血液动力学稳定.
目的 研究全痳誘導期急性超容量液體填充(acute hypervolemic fluid infusion,AHFI)對冠狀動脈粥樣硬化性心髒病患者行非體外循環冠脈徬路移植術(off-pump coronary artery bypass grafting,OPCABG)血液動力學的影響.方法 40例患者按隨機數字錶法隨機分為6％羥乙基澱粉130/0.4 (6％ hydroxyethyl starch 130/0.4,HES 130/0.4)組和乳痠林格液(lactated ringer's solution,RL)組,每組20例.全痳誘導前5 min開始,30 min內分彆輸註HES 130/0.4或RL10 ml/kg.在痳醉誘導前5min(T0),誘導後即刻(T1),插管後即刻(T2),插管後5 min(T3)及AHFI結束後(T4)分彆記錄心率(HR),血壓(BP),中心靜脈壓(central venous pressure,CVP),心髒指數(cardiac index,CI),每搏輸齣量(stroke volume,SV)及每搏變異指數(stroke volume variation,SVV). 結果 與T0時HR[(66.2±9.5)次/min、平均動脈壓(mean arterial pressure,MAP)[(98.6±12.5) mm Hg(1 mm Hg=0.133 kPa)]、CI[(2.7±0.4)L·min-1·m-2]、SV [(82.5±17.4) ml]及SVV[(8.6±4.3)％]比較,HES130/0.4組患者T1時MAP[(82.3±10.8) mm Hg]、CI[(2.3±0.3)L·min-1·m-2]及SV [(73.4±15.5) nl]均下降；在T3和T4時HR[(57.8±6.2)次/min和(56.4±6.9)次/min ]下降；T4時CI[(3.2±0.4)L·min-1· m-2]升高,但是SVV[(6.3±3.2)％]降低(P＜0.05)；而RL對照組在T1、T3及T4時MAP[ (78.8±12.1) 、(82.7±12.9)、(79.2±10.1) mm Hg]和SV[(71.3±16.2)、(73.6±15.9)、(74.4±16.3)ml]均降低(P＜0.05或P＜0.01).在T3時與RL對照組CI[(2.5±0.4)L·min-1·m-2]和SV[( 73.6± 15.9) ml]比較,HES 130/0.4組CI[(3.0±0.5)L·min-1·m-2]和SV [(91.2±18.6) ml]均升高(P＜0.05).在T4時與RL對照組MAP[ (79.2±10.1) mm Hg] 、CI[(2.6±0.4)L·min-1· m-2] 、SV[ (74.4±16.3) ml]和SVV[(10.6±4.5)％)]比較,HES130/0.4組MAP[(88.2±9.4)mm Hg]、CI[(3.2±0.4)L·min-1·m-2]和SV[(91.2±18.6)％]均升高,但SVV[(6.3±3.2)％]明顯降低(P＜0.05).結論 OPCABG全痳誘導期行AHFI安全有效,使用HES130/0.4比RL能更好地維持全痳誘導期間的血液動力學穩定.
목적 연구전마유도기급성초용량액체전충(acute hypervolemic fluid infusion,AHFI)대관상동맥죽양경화성심장병환자행비체외순배관맥방로이식술(off-pump coronary artery bypass grafting,OPCABG)혈액동역학적영향.방법 40례환자안수궤수자표법수궤분위6％간을기정분130/0.4 (6％ hydroxyethyl starch 130/0.4,HES 130/0.4)조화유산림격액(lactated ringer's solution,RL)조,매조20례.전마유도전5 min개시,30 min내분별수주HES 130/0.4혹RL10 ml/kg.재마취유도전5min(T0),유도후즉각(T1),삽관후즉각(T2),삽관후5 min(T3)급AHFI결속후(T4)분별기록심솔(HR),혈압(BP),중심정맥압(central venous pressure,CVP),심장지수(cardiac index,CI),매박수출량(stroke volume,SV)급매박변이지수(stroke volume variation,SVV). 결과 여T0시HR[(66.2±9.5)차/min、평균동맥압(mean arterial pressure,MAP)[(98.6±12.5) mm Hg(1 mm Hg=0.133 kPa)]、CI[(2.7±0.4)L·min-1·m-2]、SV [(82.5±17.4) ml]급SVV[(8.6±4.3)％]비교,HES130/0.4조환자T1시MAP[(82.3±10.8) mm Hg]、CI[(2.3±0.3)L·min-1·m-2]급SV [(73.4±15.5) nl]균하강；재T3화T4시HR[(57.8±6.2)차/min화(56.4±6.9)차/min ]하강；T4시CI[(3.2±0.4)L·min-1· m-2]승고,단시SVV[(6.3±3.2)％]강저(P＜0.05)；이RL대조조재T1、T3급T4시MAP[ (78.8±12.1) 、(82.7±12.9)、(79.2±10.1) mm Hg]화SV[(71.3±16.2)、(73.6±15.9)、(74.4±16.3)ml]균강저(P＜0.05혹P＜0.01).재T3시여RL대조조CI[(2.5±0.4)L·min-1·m-2]화SV[( 73.6± 15.9) ml]비교,HES 130/0.4조CI[(3.0±0.5)L·min-1·m-2]화SV [(91.2±18.6) ml]균승고(P＜0.05).재T4시여RL대조조MAP[ (79.2±10.1) mm Hg] 、CI[(2.6±0.4)L·min-1· m-2] 、SV[ (74.4±16.3) ml]화SVV[(10.6±4.5)％)]비교,HES130/0.4조MAP[(88.2±9.4)mm Hg]、CI[(3.2±0.4)L·min-1·m-2]화SV[(91.2±18.6)％]균승고,단SVV[(6.3±3.2)％]명현강저(P＜0.05).결론 OPCABG전마유도기행AHFI안전유효,사용HES130/0.4비RL능경호지유지전마유도기간적혈액동역학은정.
Objective To investigate the effects on hemodynamic efficacy of acute hypervolemic fluid infusion (AHFI)during induction of general anesthesia in patients undergoing off-pump coronary artery bypass surgery. Methods Five minutes before induction of general anesthesia,forty patients undergoing off-pump coronary artery bypass surgery were randomized to receive 10 ml/kg of low-molecular 6％ hydroxyethyl starch 130/0.4 (HES 130/0.4 group,n=20) or lactated ringer's solution (RL group,n=20),within 30 min.Heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP),central venous pressure (CVP),cardiac index (CI),stroke volume (SV),and stroke volume variation (SVV) were recorded 5 min before induction of anesthesia (T0,baseline),immediately after anesthetic induction (T1),immediately after intubation (T2),5 min after intubation (T3),and after the end of AHFI (T4). Results Compared with T0,mean arterial pressure (MAP),CI and SV were significantly decreased at T1 [from (98.6±12.5) mm Hg( 1 mm Hg =0.133 kPa),(2.7±0.4) L·min-1·m-2,and (82.5±17.4) ml to (82.3±10.8) mm Hg, (2.3±0.3) L·min-1·m-2 and (73.4±15.5) ml,respectively.](P＜0.05),HR was significantly decreased at T3 and T4 [from (66.2±9.5) bpm to (57.8±6.2) bpm and (56.4±6.9) bpm,respectively),CI was significantly decreased at T4 [from (2.3± 0.3) L·min-l·m-2 to (3.2±0.4) L·min-1·m-2],but SVV was significantly increased at T4 [from (8.6±4.3)％ to(6.3±3.2)％ ] in HES140/0.4 groups.However,MAP and SV were significantly decreased at T1 [(78.8±12.1 )mm Hg and (71.3±16.2) ml],T3 [(82.7±12.9) mm Hg and (73.6±15.9) ml],and T4 [(79.2±10.1) mm Hg and (74.4±16.3) ml]in RL group (P＜0.05,or P＜0.01 ).Compared with RL group,CI and SV were significantly increased at T3 [from (2.5±0.4) L·min-1·m-2 and (73.6± 15.9) ml to (3.0±0.5) L· min-1· m-2 and (91.2± 18.6) ml,respectively.] (P＜0.05).MAP,CI,and SV were significantly increased at T4 [from(88.2±9.4) mum Hg,(3.2±0.4) L·min-1·m-2,and (91.2±18.6) ml to (79.2±10.1) mm Hg,(3.0±0.5) L·min-1·m-2 and (91.2±18.6) ml,respectively] (P＜0.05) in HES140/0.4 groups.However,SVV was significantly decreased at T4 [from (10.6±4.5)％ to (6.3±3.2)％ ] (P＜0.05). Conclusions Acute hypervolemic fluid infusion during the induction of general anesthesia is a safe and efficient method in patients undergoing off pump coronary artery bypass grafting.As compared with lactated ringer's solution,HES140/0.4 maintains a better status of hemodynamic processes.
