| 急性高容量血液稀释对肝切除手术患者肺换气功能的影响 |
| 投稿时间：2017-04-17 修订日期：2017-05-16 点此下载全文 |
| 引用本文：倪纯珏,陈顺利,胡一,林丽娜,王良荣,金建国.急性高容量血液稀释对肝切除手术患者肺换气功能的影响[J].医学研究杂志,2018,47(2):127-131 |
| DOI：
10.11969/j.issn.1673-548X.2018.02.030 |
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| 基金项目:温州市科技计划项目（Y20140329） |
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| 中文摘要:目的 探讨急性高容量血液稀释（AHH）对肝脏切除手术患者肺换气功能的影响及可能机制。方法 选取2013年10月~2014年7月在笔者医院进行肝切除手术患者45例，将患者随机分为试验组（A组）和对照组（B组），于全身麻醉气管插管后A组快速输注琥珀酰明胶行AHH；B组常规速度补液，记录两组围术期血流动力学指标、液体出入量、麻黄碱用量和术野Fromme评分；分别于术前（T0）、AHH后30min （T1）、AHH后6h （T2）、AHH后24h （T3）抽取动脉血行血气分析，计算肺泡-动脉氧分压差（A-aDO2）和分流率（Qs/Qt）值，测定血浆IL-1β、IL-10、TNF-α浓度。结果 A组MAP在稀释后（硬膜外起效）、肿块切除后、术毕较平稳，B组则下降明显，A组稀释后CVP高于稀释前及B组同时相值（P<0.05），但均值处于正常范围。A、B两组输液量、总出血量、尿量及术野Fromme评分比较，差异无统计学意义（P>0.05），A组术中输血量及麻黄碱用量明显低于B组（P<0.05）。与T0时比较，两组A-aDO2在T1、T2、T3升高（P<0.05），且T2、T3时点A组A-aDO2高于B组（P<0.05）；两组T1、T2、T3时点的IL-1β、IL-10及TNF-α水平升高（P<0.05）；且T2、T3时点A组IL-1β、IL-10及TNF-α水平高于B组（P<0.05）。结论 急性高容量血液稀释用于肝脏切除手术可维持术中血流动力学相对稳定，但同时激发炎性反应和围术期肺换气功能障碍，是实施高容量血液稀释可能的潜在风险。 |
| 中文关键词:急性高容量血液稀释 肝切除手术 肺换气功能 炎性反应 |
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| Effect of Acute Hypervolemic Hemodilution on Pulmonary Gas Exchange in Patients Undergoing Hepatectomy |
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| Abstract:Objective To investigate the influence of acute hypervolemic hemodilution on pulmonary gas exchange and inflammatory cytokines in hepatectomy.Methods Totally 45 patients with hepatectomy were as the research objects,and they were divided into 2 group:AHH group and control group. All patients were treated with general anesthesia combined with epidural anesthesia. Calculated voluven was then infused over 50 ml/min in AHH group,while those in control group were treated with conventional fluid infusion.MAP,HR and CVP were monitored during anesthesia.The blood transfusion and blood loss of the patients were measured in two group, the operation doctor underwent Fromme scores of operation field on patients in two groups.A-aDO2,Qs/Qt, TNF-α,IL-1β,IL-10 were measured pre-operation(T0), 30 minutes after AHH(T1),6 hours after AHH(T2) and 24 hours after AHH(T3).Results MAP was more stable during operation in AHH group than in control group.CVP was significantly increased after infusion of HES in AHH group(P<0.05),but still within normal range.The volume of blood infused and methamphetamine use were significantly reduced in AHH group as compared with control group(P<0.05). There were no significant differences in Fromme scores of operation between the two groups. Compared with T0, A-aDO2,Qs/Qt and serum levels of TNF-α,IL-1β,IL-10 increased at T1-T3 in all groups(P<0.05).Compared with group B, A-aDO2,Qs/Qt and serum levels of TNF-α,IL-1βincreased at T2-T3 in group A(P<0.05).Conclusion AHH in hepetactomy can reduce the volume of blood infused, avoid the danger of allogenic blood transfusion in the majority of hepetactomy. However,we find AHH could influence the pulmonary gas exchange after the liver resection operation,which may be an important potential risk for AHH. |
| keywords:Acute hypervolemic hemodilution Hepatectomy Pulmonary gas exchange Inflammation response |
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