贺斯行急性超容性血液稀释时对机体血液动力学及凝血功能的影响

目的　观察羟乙基淀粉 (6 %贺斯 2 0 0 0 .5 ,HES)行急性超容性血液稀释 (AHHD)时血液动力学、血气及凝血功能的变化。方法　选择ASAⅠ -Ⅱ级在硬外复合浅全麻下行食道癌根治及全髋置换手术患者 5 0例 ,麻醉前 30～4 0min内输入HES(15mL·kg- 1 ) ,使血容量增加 2 0 %。当Hb低于 90 g·L- 1 时输入同型异体血。术中连续监测HR、BP、SpO2 ,于HD前 (H0 )、HD后 15min(H1 )、输入同型异体血前 (H2 )以及术毕 (H3)各时点抽取动、静脉血行血气分析、血常规及凝血功能检测。结果　HR、BP在整个手术过程中无明显变化 (P >0 .0 5 ) ;Hb、Hct在HD后各时点均降低 (P <0 .0 5或P <0 .0 1)。PT在HD后H1 、H2 ,FIB在H2 时均明显降低 (P <0 .0 5或P <0 .0 1)。结论　采用HES行AHHD对心、肺、肝、肾及凝血功能正常患者行血液保护是安全有效的 ,可避免异体血不必要的输入

The hemodynamics and blood coagulation changes affected by acute hypervolemic hemodilution

Objective To observe the hemodynamics and blood coagulation changes during acute hypervolemic hemodilution (AHHD) with HES infusion. Methods The blood volume was increased by 20% by HES infusion (15?mL·kg -1),30～40?min before anesthesia in 50 ASA Ⅰ-Ⅱ patients who underwent different surgeries. Blood transfusion was not undertaken unless Hb decrease was below 90?g·L -1. The blood test, coagulation state,blood gas analysis HR, BP and SpO 2 were continuously investigated at H o (before HES infusion), H 1 (15?min after HES infusion), H 2 (before blood transfusion) and H 3 (after operation). Results The HR, SP, DP and MAP had no significant changes (P> 0.05);Hb and Hct decreased continuously after hemodilution (P< 0.05 or P< 0.01); PT decreased greatly at H 1 and H 2; FIB decreased greatly at H 2 (P< 0.05 or P< 0.01). Conclusion Acute hypervolemic hemodilution with HES infusion provides an effective protection for patients with normal cardiopulmonary, renal, hepatice function and normal coagulation. It plays an important role in avoiding unnessary blood transfusion.