6%羟乙基淀粉行急性超容血液稀释对血电解质及酸碱平衡影响.docVIP

6%羟乙基淀粉行急性超容血液稀释对血电解质及酸碱平衡影响 　作者：张明军，韩晗，邱丽琳，蒋秋蓉，金淑君 【摘要】 　　目的 探讨6%羟乙基淀粉溶液（HES，200/0.5）行急性超容血液稀释（AHHD）对机体血电解质及酸碱平衡的影响。方法 选择20例20～40岁、ASAⅠ～Ⅱ级择期五官科手术插管全麻患者，以6%HES15 ml/kg 扩容行中度血液稀释。于AHHD前、AHHD后、手术结束时测定Hct、Hb、血电解质及酸碱平衡指标进行比较。结果 AHHD后、手术结束时Hct、Hb较AHHD前显著降低，AHHD后Hct、Hb分别下降了23.1%和21.4%，达到中等程度血液稀释状态；AHHD后血K+浓度下降了13.65%，血Ca2+浓度也明显下降了39.80%，但均在正常范围内；AHHD前、后pH值及血Na+浓度变化差异均无统计学意义。结论 6%HES溶液行AHHD能有效地使Hct及Hb下降至靶水平，同时维持了机体血电解质的稳定及酸碱平衡，是一种安全有效的AHHD方法。 【关键词】 急性超容血液稀释；血浆代用品；血液成分 　　Abstract： Objective To investigate the effect of acute hypervolemic hemodilution (AHHD) with 6% of HES on blood electrolytes and acid-base balance.Methods Twenty patients (ASA Ⅰ-Ⅱ, 20-40 years old) were selected and scheduled for ophthalmologic and otorhinolaryngologic operation under general anesthesia. They received 6% of HES (15ml/kg) for moderate hemodilution. Arterial blood samples were taken for determination of HCT, Hb, K+, Na+, Ca2+ and pH before and after AHHD, and at the end of surgical operation.Results HCT and Hb significantly decreased after AHHD. HCT and Hb descended respectively by 23.1% and 21.4%, which reached the state of moderate hemodilution. K+ and Ca2+ after AHHD were decreased by 13.65% and 39.80%, respectively, but within mormal limits. The variation of pH and Na+ before and after AHHD had no statistic difference.Conclusion AHHD with 6% of HES can make HCT and Hb decrease to target level effectively, while maintaining the blood electrolyte and acid-base balance. It is a safety and effect method for hemodilution. 　　Key words： acute hypervolemic hemodilution; plasma substitute; blood component 血液稀释作为外科手术中血液保护的一种理想方法已广泛应用于临床实践，它能有效地减少术中血液成分的丢失，同时较好地维持组织灌注与氧输送[1]。急性超容性血液稀释（acute hypervolemic hemodilution，AHHD）通过术前输入15～20 ml/kg 的胶体液，使机体血容量扩大20%～30%，从而达到减少自体血丢失，提高机体失血耐受性及节约用血的目的。本研究观察6%羟乙基淀粉（HES，200/0.5）行AHHD的有效性及其对血电解质和酸碱平衡的影响，并探讨其安全性。 　　1 对象和方法 　　1.1 对象 　　选择20例ASAⅠ～Ⅱ级择期五官科手术患者，年龄20～40岁，体重50～70 kg，身高161～172 cm。纳入标准：术前Hct≥35%～40%，Hb≥110～130 g/L，肝肾功能、心肺功能、血生化指标、凝血酶原时间（PT）、部分活化凝血酶时间（APTT）