深度血液稀释后家兔脑组织TNF-α生成量的变化

目的 监测深度血液稀释后家兔脑组织肿瘤细胞坏死因子α(TNF-α)生成量的变化.方法 健康成年家兔18只,体重2～2.5 kg,随机分为A,B,C三组,每组6只.A、B两组以6%羟乙基淀粉(200/0.5)行血液稀释,目标血细胞比容(Hct)分别为A组12%、B组18%,C组不进行血液稀释.麻醉下气管插管后行机械通气,维持体温37℃左右.左颈内静脉穿刺置管,以备采取血样;右股动脉穿刺置管以备抽取血液样本及监测动脉压.股动脉放血,同时A组、B组股静脉输注等量6%羟乙基淀粉行等容性血液稀释(ANH)至目标Hct约30 min.于动脉、静脉穿刺置管后20 min(T0)、ANH后2 h(T1)、4 h(T2)、8 h(T3)时,记录SBP、DBP、MAP、CVP和HR;分别采集静脉血样各0.4 ml,采用酶联免疫吸附法(ELISA)测定脑组织TNF-α生成量.结果 与T0时比较,A组T1～T3、B组T2、T3动、静脉血TNF-α浓度升高(P<0.05);各时点C组脑组织TNF-α生成量比较差异无统计学意义.结论 常温下ANH目标Hct为18%及12%均不能维持脑氧供需平衡,可导致脑缺氧性炎症.     

不同程度急性等容量血液稀释对家兔血清S-100B蛋白浓度和脑氧代谢的影响

目的 探讨常温下不同程度急性等容量血液稀释(ANH)对家兔血清S-100B蛋白浓度和脑氧代谢的影响.方法 健康成年家兔32只,体重2～2.5 kg,随机分为4组(n=8),对照组(Ⅰ组)不行血液稀释;其余3组血液稀释的目标红细胞压积(Hot)分别为24%(Ⅱ组)、18%(Ⅲ组)、12%(Ⅳ组).麻醉下气管插管后行机械通气,维持体温37℃左右.左颈动脉和左颈内静脉穿刺并置管,用于监测血压、采血和血气分析.右颈内静脉穿刺并置管,用于监测中心静脉压.股动脉放血,同时Ⅱ组～Ⅳ组股静脉经30 min输注等量6%羟乙基淀粉200/0.5行ANH至目标Hct.于动脉、静脉穿刺并置管稳定20 min(To)、ANH后2、4、8 h(T1～T3)时,记录血液动力学指标;分别采集左颈动脉和左颈内静脉血样各0.1 ml,行血气分析,计算脑氧摄取率(CERO2);颈动脉取血样,采用ELISA法测定血清S-100B蛋白浓度.ANH后8 h时处死动物,取右侧脑组织,称湿重和干重,计算脑含水量.结果 与T0时比较,Ⅲ组T3时、Ⅳ组T1～T3时CERO2和血清S-100B蛋白浓度升高(P<0.05);Ⅰ组和Ⅱ组各时点CERO2和血清S-100B蛋白浓度比较差异无统计学意义(P>0.05);与Ⅰ组和Ⅱ组比较,Ⅲ组T3时、Ⅳ组T1～T3时CERO2和血清S-100B蛋白浓度升高(P<0.05);与Ⅲ组比较,Ⅳ组T1～T3时CERO2和血清S-100B蛋白浓度升高(P<0.05).各组问脑含水量比较差异无统计学意义(P>0.05).结论 常温下ANH目标Hct为24%时,对家兔脑氧代谢无影响;目标Hct≤18%时,发生脑氧代谢失衡和脑损伤.     

不同程度急性高容量血液稀释时家兔小肠和全身氧代谢的变化

目的评价不同程度急性高容量血液稀释(AHHD)对家兔小肠及全身氧代谢的影响。方法5月龄健康家兔12只,体重2．4-2．9kg。全身麻醉后,静脉输注4％琥珀酰明胶70ml-1·kg-1·h-1行AHHD,使Hct分别达到25％(H1)、20％(H2)、15％(H3)、10％(H4)4种程度,每种程度维持30 min。抽取股动脉、颈内静脉、肠系膜上动脉及肠系膜上静脉血标本,测定血液稀释前(H0)及4种程度下进行血气分析,测定血乳酸(Lac)浓度,计算动脉血氧含量(CaO2)、静脉血氧含量(CvO2)、氧摄取率(ERO2)、静脉-动脉乳酸含量差(v-aLac)。结果与H0比较,全身及小肠vLac、v-aLac在H4时升高,ERO2在H3、H4时升高(P<0．01);与H3比较,H4时ERO2、aLac、vLac、v-aLac升高(P<0．01);全身及小肠CaO2、CvO2随血液稀释程度的加深而降低(P<0．01)。全身及小肠血气分析结果与Lac变化趋势基本一致。结论Hct在15％～25％是保证家兔小肠和全身氧供的安全的血液稀释范围。     

急性等容血液稀释联合低中心静脉压对肝癌手术脑氧代谢的影响

目的观察急性等容血液稀释(ANH)联合低中心静脉压(LCVP)在肝癌手术中对患者脑氧代谢的影响。方法拟行肝癌手术患者40例,随机均分为两组。ANH+LCVP组全麻后先进行ANH,然后进行LCVP控制,在肝脏实质完全离断前CVP控制在0～5cmH2O,肝实质切除止血彻底后将CVP恢复至7～8cmH2O;常规治疗组手术中CVP维持在7～8cmH2O。分别于入室后(T0)、采血后5min(T1)、肝癌切除后5min(T2)、恢复容量后5min(T3)抽取动脉、颈内静脉球部的血作血气分析,检测动脉、颈内静脉血氧饱和度(SaO2、SjvO2)、动脉、颈内静脉血氧分压(PaO2、PjvO2)、Hb和Hct,并计算动脉、颈内静脉球部血氧含量(CaO2、CjvO2)、脑氧摄取率(CERO2)、动脉、颈内静脉球部血氧含量差(Da-jvO2)和乳酸差(VADL)。结果与T0时比较,T2、T3时两组Hb、Hct值明显降低(P<0.05),T1～T3时ANH+LCVP组SjvO2明显升高(P<0.05),CERO2、Da-jvO2明显降低(P<0.05),T2、T3时常规治疗组CERO2、Da-jvO2明显降低(P<0.05)。与T2时比较,T3时ANH+LCVP组Hb、Hct值明显升高(P<0.05),常规治疗组明显下降(P<0.05)。与常规治疗组比较,ANH+LCVP组T1、T2时Hb、Hct值明显降低、而T3时明显升高(P<0.05),T1～T3时SjvO2、T3时Da-jvO2明显升高(P<0.05);而T1时Da-jvO2明显降低(P<0.05)。结论急性等容血液稀释联合低中心静脉压技术可以安全应用于肝癌手术中,对脑氧代谢无明显不良影响。     

丙泊酚对血液稀释时组织氧代谢的影响

目的　观察丙泊酚对急性等容血液稀释 (ANH)时组织氧代谢的影响。方法　择期手术病人 2 4例 ,随机分为三组 ,每组 8例 :A组为ANH组 ,P4组为ANH +丙泊酚 4mg组 ,P8组为ANH +丙泊酚 8mg组 ,三组病人ANH后Hct降至 2 7 1 %。漂浮导管放置完成后稳定 2 0min(T1 ) ,P4和P8组给予丙泊酚负荷剂量 2mg/kg后 ,分别给与丙泊酚维持剂量 (P4组 :4mg·kg-1 ·h-1 ;P8组 :8mg·kg-1 ·h-1 )。稳定 1 0min后 (T2 ) ,开始进行血液稀释。同时于T1 、T2 、T3 (血液稀释完成后1 5min)分别监测血液动力学指标和混合静脉血氧饱和度 (S vO2 ) ,血乳酸值 (T1 、T3 )。结果　三组病人ANH后均可见心排血量 (CO) ,每搏量 (SV)升高非常显著 ,外周血管阻力 (SVR)和动脉血氧含量(CaO2 )下降非常显著 ,氧供给 ( DO2 )、S vO2 及血乳酸改变不明显 ;P4和P8组SVR下降显著 ,MAP下降非常显著 ,组间比较无差异。结论　本实验剂量范围内 ,丙泊酚与ANH合用时 ,组织氧代谢水平未受明显影响     

不同种类液体急性等容血液稀释对脊柱手术患者血流动力学的影响和血液保护效应

目的观察不同种类液体急性等容血液稀释(ANH)对脊柱手术患者血流动力学的影响和血液保护效应。方法选择择期全麻下行后路脊柱手术的患者60例,男30例,女30例,年龄48~65岁,ASAⅠ或Ⅱ级,随机分为三组:ANH晶体组(A组)、ANH胶体组(B组)和对照组(C组),每组20例。A组和B组在俯卧位全麻下行ANH,目标Hct为32%,A组放血同时用3倍体积的复方乳酸钠稀释,B组放血同时用相同体积的羟乙基淀粉130/0.4氯化钠注射液稀释,C组不做ANH,为对照组。记录ANH前5 min(俯卧位后5 min,T0)、ANH结束后10 min(切皮前5 min,T1)、输血(包括异体血和自体血)前5min(T2)和输血结束后10min(T3)的MAP、HR、心脏指数(CI)、每搏量变异度(SVV)、Hb、Hct、Plt、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及BIS和体温;监测三组术中出血量、输血量(包括悬浮红细胞、血小板和新鲜冰冻血浆)、输注异体血患者例数、输液量及尿量。结果 T2、T3时A组MAP明显低于,SVV明显高于T0时和B、C组(P0.05);T1时A、B组CI明显高于T0时和C组(P0.05),T2、T3时B、C组CI明显高于T0时和A组(P0.05);T1、T3时A、B组Hb、Hct及Plt明显低于T0时(P0.05);T1、T2时A、B组Hb、Hct及Plt明显低于C组,T3时明显高于C组(P0.05);T2、T3时三组PT及APTT明显长于T0时,T3时A、B组PT及APTT明显短于C组(P0.05)。A、B组术中未输入悬浮红细胞,输入悬浮红细胞及输注异体血患者例数明显少于C组(P0.05);A组晶体液输入量明显多于B、C组,B组明显少于C组(P0.05);A、C组胶体液输入量明显少于B组(P0.05);A组尿量明显多于B、C组(P0.05)。三组术中出血量差异无统计学意义。结论 ANH可减少脊柱手术患者术中异体悬浮红细胞的输入量,有利于凝血功能的恢复,具有明显的血液保护效应;胶体液行ANH的扩容效果优于晶体液。     

羟乙基淀粉200/0.5和羟乙基淀粉130/0.4术前急性高容量血液稀释对结肠癌根治术患者血液流变学的影响

目的 评价6%羟乙基淀粉(HES)200/0.5和6%HES 130/0.4术前急性高容量血液稀释(AHH)对结肠癌根治术患者血液流变学的影响.方法 择期在全麻下行结肠癌根治术患者40例,ASA Ⅰ或Ⅱ级,随机分为2组(n=20),麻醉诱导期间于30 min内静脉输注15 ml/kg HES 200/0.5(Ⅰ组)或HES 130/0.4(Ⅱ组),AHH结束后开始手术.分别于麻醉诱导前(基础状态,T0)、AHH后即刻(T1)、AHH结束后1 h(T2)和术后1 h(T3)时抽取静脉血样,检测全血粘度、血浆粘度、红细胞聚集指数、血小板聚集指数和红细胞压积(Hct).结果 与T0时比较,Ⅰ组T1时全血低切粘度和红细胞聚集指数降低,T1-3时全血中切粘度、全血高切粘度、血浆粘度、血小板聚集指数和Hct降低,Ⅱ组T1-3时全血低切粘度、全血中切粘度、全血高切粘度、血浆粘度、红细胞聚集指数和Hct降低(P<0.05);与Ⅰ组比较,Ⅱ组T2,3时全血低切粘度和红细胞聚集指数降低,T1-3时血小板聚集指数升高(P<0.05).结论 6%HES 200/0.5与6%HES 130/0.4(15 ml/kg)术前AHH均能改善结肠癌根治术患者围术期血液流变学,其中6% HES 130/0.4的效果较好.     

不同程度急性高容量血液稀释对全麻病人内脏氧合和全身炎性反应的影响

目的 研究4%琥珀酰明胶(MFG)不同程度急性高容量血液稀释(AHH)对全麻病人内脏氧合及全身炎性反应(SIRS)的影响.方法 20例骨肿瘤病人,随机均分为目标稀释值Hct30%组(I组)和Hct 25%组(Ⅱ组).麻醉诱导后30米min内连续输入预设量MFG.分别于麻醉诱导后(T0)、MFG输注15 min(Ti)、输注结束(T2)、MFG输注结束后15 min(T3)和30 min(T4)监测胃黏膜pH值(I-pH)、胃黏膜二氧化碳分压(PgCO2)、动脉血二氧化碳分压(PaCO2),并计算PgCO2与PaCO2差值(Pg-aCO2),在T0、T2和T4时抽血测定肿瘤坏死因子α(TNF-α)含量和心房利钠多肽(ANP).结果 (1)T3时达到Hct目标值.(2)T4时I-pH<7.30的例数较稀释前显著增多(P<0.05).(3)TNF-α呈升高趋势,但差异无统计学意义;Ⅱ组ANP T2、T4时较T0时显著升高(P<0.05).结论 利用溶液-溶质关系对病人实施预定Hct目标值的AHH是可行的;但AHH可能会对全麻病人的内脏氧合造成影响,并引发SIRS.     

右美托咪定对骨科下肢手术患者止血带诱发肢体缺血-再灌注损伤的影响

目的探讨右美托咪定对骨科下肢手术患者止血带诱发肢体缺血-再灌注损伤的影响。方法择期拟行关节镜下膝关节韧带修复术患者40例,年龄18~64岁,体重44~85kg,ASA I或Ⅱ级。采用随机数字表法,将患者随机均分为右美托咪定组(D组)和对照组(C组),均采用脊椎-硬膜外联合阻滞,腰麻药物为0.5%布比卡因12~15mg,于上止血带前20min时D组静脉输注右美托咪定负荷量(输注剂量0.5μg/kg,输注时间10min),维持剂量0.5μg·kg-1·h-1直至手术结束,C组输注等容量生理盐水。于入室后(T0)、松止血带即刻(T1)、30 min(T2)时抽取术侧静脉血样,测定血浆丙二醛(MDA)和肿瘤坏死因子α(TNF-α)浓度。记录术中恶心呕吐、心动过缓等并发症的发生情况。结果与T0时比较,T1、T2时两组血浆MDA和TNF-α浓度明显升高(P0.05);与C组比较,T1、T2时D组血浆MDA及TNF-α浓度明显降低(P0.05)。结论右美托咪定似可减轻止血带诱发下肢缺血-再灌注损伤。     

不同程度血液稀释对家兔脑氧代谢的影响

目的 观察不同程度急性等容性血液稀释对常温下家兔脑氧代谢的影响.方法 32只成年家兔,随机均分为A、B、C、D四组,A、B、C三组的目标Hct分别为24%、18%、12%;D组为对照组,不行血液稀释.以20%乌拉坦行静脉麻醉后机械通气,并维持体温在37℃.监测血液稀释前后的动、静脉血气,并根据Fick's公式计算出脑氧代谢率(CERO2).结果 A组各时点CERO2与D组比较差异无统计学意义,B组CERO2在血液稀释后8 h较基础值增高,而C组CERO2在血液稀释后2、4、8 h均较基础值增高.结论 血液稀释目标Hct为24%时.对常温、有创条件下家兔脑氧代谢并无影响;日标Hct为18%时,在血液稀释后8 h可以出现CERO2增高,且血液pH值明显降低;血液稀释至Hct为12%时则不能满足脑氧代谢需求.     

6%羟乙基淀粉130/0.4和6%羟乙基淀粉200/0.5急性高容量血液稀释对全麻患者凝血功能的影响

目的 评价6%羟乙基淀粉130/0.4(6% HES130/0.4)和6%羟乙基淀粉20010.5(6% HES200/0.5)急性高容量血液稀释(AHHD)对全麻患者凝血功能的影响.方法 择期全麻手术患者60例,ASA Ⅰ或Ⅱ级,年龄18～64岁,随机分为3组(n=20):对照组(C组)、6%HES200/0.5组(H组)及6%HES130/0.4组(V组).H组和V组于麻醉诱导前90 min分别静脉输注6% HES200/0.5或6% HES130/0.4,速率20 ml·kg-1·h-1,扩容量20ml/kg;C组仅静脉输注乳酸钠林格氏液6～8 ml·kg-1·h-1.于AHHD前、AHHD后即刻及AHHD后1 h采血,进行下述指标的测定:血小板计数、凝血酶原时间(PT)、血小板最大聚集率和Sonoclot玻璃珠激活全血凝固时间(gbACT)、凝结速率(CR)、血小板功能(PF)和曲线达峰时间.H组和V组同时还测定活化部分凝血活酶时间(APTT)、凝血因子Ⅷ活性(FⅧ:C)、von Willebrand因子(vWF)水平.结果 与AHHD前比较,H组和V组AHHD后PT和APTY均延长,FⅧ:C下降(P＜0.05),但2组AHHD后1 h FⅧ:C高于AHHD后即刻(P＞0.05);H组和V组AHHD后血小板最大聚集率降低,但AHHD后1 h高于AHHD后即刻(P＜0.05).与H组比较,V组AHHD后CR降低(P＜0.05),其他凝血功能指标比较差异无统计学意义(P＞0.05).结论 6%HES130/0.4和6% HES200/0.5(20 ml/kg)AHHD对全麻患者凝血功能的抑制作用较轻;两者对凝血功能的影响无明显差异.     

Influence of volume replacement with different HES–solutions on microcirculatory blood flow in cardiac surgery

A variety of hydroxyethyl starch (HES) preparations with different molecular weight average (Mw) and molar substitution (MS) is available for volume replacement during acute normovolemic haemodilution (ANH). Particularly with regard to microcirculation, the ideal solution for volume therapy has not been found. A 5th group without ANH served as a control (10 patients in each group). In addition to systemic haemodynamics and various laboratory parameters, skin capillary blood flow was measured by laser Doppler flowmetry. Laser Doppler flow (LDF) was monitored simultaneously at the patient's forehead and forearm. Changes in systemic haemodynamics were similar in all ANH–patients. Systemic vascular resistance (SVR) was lowest after infusion of HES 200/0.5. The most pronounced increase in plasma viscosity was in patients of group 1 (450/0.7) (P<0.05) and plasma viscosity remained highest during the entire investigation period in these patients. After ANH, skin capillary blood flow measured at the forehead decreased in all patients except in patients of group 2 (200/0.5: max. + 18%). Group 3 (200/0.62) showed the highest decrease in forehead–LDF. During CPB, forehead–LDF decreased significantly in groups 3 (200/0.62) and 4 (40/0.5). At the end of the operation, LDF was most reduced in groups 1 (– 32%) and 3 (– 33%). Forearm–LDF increased in all ANH–patients. Immediately after ANH this increase was lowest in group 3 (200/0.62). In the further course of the investigation, no more differences were seen in any HES patients. The different HES preparations showed a different microcirculatory response. 6% HES 200/0.5 seems to be overall most suitable for volume replacement in cardiac surgery patients undergoing acute normovolemic haemodilution (ANH) due to the best effects on microcirculatory skin perfusion assessed by laser Doppler flow. HES 6% 200/0.62 showed the overall least positive effects with regard to skin capillary blood flow in this situation.     

The hemodynamic effects of various hydroxyethyl starch solutions in heart surgery patients]

Blood conservation is gaining more and more interest because of the increasing risks involved in homologous blood transfusions. Acute normovolemic hemodilution (ANH) is becoming an established technique even in cardiac surgery patients. The "optimal" kind of volume replacement, however, is still controversial. Thus, this study was carried out to investigate the hemodynamic response of 6 different hydroxyethyl starch (HES) solutions as volume replacement. METHODS. In 60 patients undergoing elective aortocoronary bypass surgery, acute, preoperative hemodilution was performed (10 ml/kg) and HES with different concentrations, molecular weight, and substitution was infused according to a randomized sequence: 1. 6% HES 450,000/0.7; 2. 10% HES 200,000/0.5; 3. 3% HES 200,000/0.5%; 4. 6% HES 40,000/0.5; 5. 6% HES 200,000/0.5; 6. 6% HES 200,000/0.62. All patients were monitored using a new pulmonary artery catheter that allows measurement of the right ventricular ejection fraction (RVEF), right ventricular enddiastolic volume (RVEDV), and right ventricular end systolic volume (RVESV) in addition to standard hemodynamic parameters. RESULTS. Immediately after finishing ANH the typical hemodynamic changes of hemodilution (HD) were apparent (decrease in peripheral resistance and increase in cardiac index (CI]. All 6 solutions investigated were effective in hemodynamic stabilization (no changes in mean arterial pressure (MAP), filling pressures (PCP, RAP), or heart rate (HR]. Forty min after ANH, however (before beginning extracorporeal circulation (ECC], there were significant differences between the groups: in groups 3 and 4 the increase in CI had already disappeared, and SVI in group 3 was even lower than the baseline values (-8%). In the other groups, a higher CI level remained even 40 min after ANH, which was most pronounced in groups 2 (+40%) and 5 (+43%). Right ventricular performance was not changed by ANH (RVEF unchanged in all groups). Forty min after hemodilution RVEDVI (-8%) and RVESVI (-16%) decreased significantly only in group 4, whereas in the other groups these parameters were still elevated. The most pronounced positive fluid balance after the end of ECC was found in group 4 (+850 ml); in these patients paO2 decreased significantly (-150 mmHg). CONCLUSIONS. The guarantee of stable hemodynamic conditions is a prerequisite when performing ANH in coronary surgery patients. The different physiochemical attributes of various HES solutions seem to be important, thus influencing their hemodynamic response. In this study, low-concentration (3% HES 200/0.5) and low-molecular (6% HES 40/0.5) HES solutions were less effective in stabilizing hemodynamics until the beginning of ECC. Additionally, their negative influence on fluid balance during ECC, followed by a deterioration in pulmonary function led to the conclusion that other solutions are preferable; in particular, 10% HES seems to be of advantage in these situations.     

不同羟乙基淀粉急性高容量血液稀释对大面积烧伤患者围术期凝血功能的影响

目的 评价羟乙基淀粉130/0.4(HES 130/0.4)与羟乙基淀粉200/0.5(HES 200/0.5)急性高容量血液稀释(AHH)对大面积烧伤患者围术期凝血功能的影响.方法 拟行早期切痂术的大面积烧伤患者40例,年龄18～49岁,ASAⅡ级,随机分为HES 200/0.5组(HES 200组)与HES 130/0.4组(HES 130组),每组20例,另选20名健康志愿者为正常对照组(C组).麻醉诱导开始时HES 200组和HES 130组经30 min分别静脉输注HES 200/0.5、HES 130/0.4 15 ml/kg,行AHH,C组不予任何处理.于麻醉诱导前(T0)、AHH结束即刻(T1)、AHH后1 h(T2)、术后1 h(T3)时采用流式细胞仪检测血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)、CD62P的表达水平,采用血栓弹力图描记仪测定以下指标:反应时间(R).凝血时间(K)、α角、最大振幅(MA)和凝血指数(CI).结果 与C组比较,HES 200组和HES 130组血小板GPⅡb/Ⅲa、CD62P表达上调,R、K缩短,α角、MA、CI增大(P<0.05);与HES 200组比较,HES 130组血小板GPⅡb/Ⅲa、CD62P表达上调,R缩短,α角、MA和CI增大(P<0.05);与T0时比较,HES 200组AHH后血小板GPⅡb/Ⅲa、CD62P表达下调,R、K延长,α角、MA、CI减小(P<0.05),HES 130组R、K延长,α角、CI减小(P<0.05),MA和血小板GPⅡb/Ⅲa、CD62P差异无统计学意义(P>0.05).结论 HES 200/0.5 AHH可抑制大面积烧伤患者围术期血小板过度活化,其减轻血液高凝状态的效应强于HES 130/0.4.     

术前静脉输注6%羟乙基淀粉200/0.5溶液对患者术后免疫功能的影响

目的 探讨术前静脉输注6%羟乙基淀粉(HES)200/0.5溶液对患者术后免疫功能的影响.方法 择期胆囊切除术患者40例,年龄21～58岁,体重47～79 kg,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组(n=20):6%HES 200/0.5组(H组)和复方醋酸钠组(A组).麻醉诱导前经15 min静脉输注6%HES 200/0.5溶液或复方醋酸钠溶液10 ml/kg.于术前、术后1 h、术后1和3 d时取静脉血样,测定血清IL-6、IL-8、TNF-α、IL-2和IL-10以及IgG、IgA和IgM的浓度.结果 与术前比较,两组患者术后血清IL-6、IL-8、TNF-α、IL-2和IL-10浓度均升高,A组术后血清IgA和IgG浓度降低(P＜0.05或0.01),IgM浓度差异无统计学意义,H组上述指标差异无统计学意义(P＞0.05);与A组比较,H组术后血清IL-6、IL-8和TNF-α浓度降低,IL-2、IL-10、IgA和IgG浓度升高(P＜0.05).结论 术前静脉输注6%HES 200/0.5溶液可改善患者术后的免疫功能.

Abstract：

Objective To investigate the effect of 6 % hydroxyethyl starch (HES) 200/0.5 infusion before operation on postoperative immne function in patients. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 21-58 yr weighing 47-79 kg were randomly divided into 2 groups ( n = 20 each): 6% HES 200/0.5 group (group H) and compound sodium acetate group (group A). 6% HES 200/0.5 10 ml/kg or compound sodium acetate solution was infused intravenously over 15 min before anesthesia induction. Anesthesia was induced with iv injection of propofol, fentanyl and vecuronium and maintained with target-controlled infusion of propofol and infusion of remifentanil. Venous blood samples were collected before operation and at 1 h, 1 day and 3 days after operation to detect the serum concentrations of IL-6, IL-8, TNF-α, IL-2, IL-10, IgG, IgA andIgM. Results Serum concentrations of IL-6, IL-8, TNF-α, II-2 and IL-10 were significantly higher after operation in the two groups, and serum concentrations of IgA and IgG were significantly lower after operation in group A than those before operation ( P ＜ 0.05 or 0.01 ). Serum concentrations of IL-6, IL-8 and TNF-α were significantly lower, while serum concentrations of IL-2, IL-10, IgA and IgG were significantly higher after operation in group H than in group A ( P ＜0.05). Conclusion Preoperative infusion with 6% HES 200/0.5 can improve the immune function after operation in patients.     

Plasma substitution effects of a new hydroxyethyl starch HES 130/0.4 compared with HES 200/0.5 during and after extended acute normovolaemic haemodilution

Background. The volume expansion effect of a recently introducedhydroxyethyl starch, HES 130/0.4, was compared with the commonlyused HES 200/0.5 after rapid infusion of a single large dose(up to 2 litres) administered during acute normovolaemic haemodilution(ANH). Methods. This prospective, randomized, double-blind study included40 patients scheduled for major abdominal surgery with no contraindicationto ANH. Patients were randomized to undergo ANH with eitherHES 130/0.4 (n=20) or HES 200/0.5 (n=20). Blood was collectedto reach a target haemoglobin level of about 8.0 g dl^–1and simultaneously replaced by the same volume of colloid (HES130: 1825 [SD 245] ml; HES 200: 1925 [183] ml). Heart rate,mean arterial pressure, cardiac filling pressure, and cardiacoutput were measured before induction of anaesthesia (baseline),10 min after completion of ANH, before surgery, at the end ofsurgery and on the following morning (postoperative day 1; POD1).ANH blood was systematically retransfused during surgery orbefore POD1. Results. Exchange of about 40% of blood volume resulted in similarhaemodynamic changes in both groups. Filling pressures increasedsignificantly, while cardiac index remained unchanged (HES 130:from 3.3 [0.4] to 3.2 [0.7] litre min^–1 m^–2; HES200: from 3.0 [0.6] to 3.1 [0.7] litre min^–1 m^–2).Need for crystalloids and colloids was similar between the groupsduring surgery and on POD1. Total blood loss (HES 130: median2165 ml, range 660–2970 ml; HES 200: median 2464 ml, range640–19 380 ml) and amount of allogeneic red blood cellstransfused (HES 130: median 0, range 0–4 units; HES 200:median 0, range 0–18 units) were comparable in the twogroups. Conclusions. This study demonstrates a good immediate and medium-termplasma volume substitution effect of HES 130 compared with HES200. HES 130 could represent a suitable synthetic colloid forplasma volume substitution during extensive ANH. Br J Anaesth 2003; 91: 196–202     

剖宫产术前急性高容量血液稀释对产妇高凝状态的影响

目的 观察羟乙基淀粉(HES)术前急性高容量血液稀释(AHHD)对剖宫产产妇高凝状态的影响.方法 择期行剖宫产的产妇40例,随机均分为两组.术前30 min内输注15 ml/kgHES 200/0.5(H组)或复方乳酸钠(RL)(R组).抽取静脉血标本,采用血栓弹力描记仪检测麻醉前(T0)、AHHD结束后即刻(T1)、1 h(T2)、4 h(T3)时的凝血状态.结果 与T0比较,H组与R组产妇的TEG参数R值在T1时明显延长(P＜0.05);H组的TEG参数ANG、MA、CI在T1、T2、T3时明显减小(P＜0.05),R组仅在T3时明显增加(P＜0.05).与R组比较,H组在T1～T3时的TEG参数ANG、MA、CI明显减小(P＜0.05).结论 剖宫产术前采用HES 200/0.5行AHHD能减轻剖宫产围术期产妇的高凝状态,对预防术后静脉血栓形成可能有一定的作用.     

Large-dose Hydroxyethyl Starch 130/0.4 Does Not Increase Blood Loss and Transfusion Requirements in Coronary Artery Bypass Surgery Compared with Hydroxyethyl Starch 200/0.5 at Recommended Doses

Background: Hydroxyethyl starch (HES) 130/0.4 may impair blood coagulation less than other HES solutions and, thus, may be used at larger doses without increasing the risk of postoperative bleeding. This study tested the hypothesis that volume replacement with 6% HES 130/0.4 at a dose of up to 50 ml/kg does not increase blood loss and transfusion requirements in elective coronary artery bypass surgery compared with 6% HES 200/0.5 at a dose of up to 33 ml/kg.

Methods: One hundred twenty adult patients scheduled for elective coronary artery bypass surgery were randomized to receive up to 50 ml/kg of 6% HES 130/0.4 or up to 33 ml/kg of 6% HES 200/0.5 for volume replacement during surgery and until 24 h thereafter. Volume requirements in excess of the respective maximum dose of HES were treated with gelatin. Colloid use was at the discretion of the attending physicians and not dictated by protocol. The primary outcome variable was chest tube drainage volume during the first 24 h after surgery.

Results: The data from 117 patients (HES 130/0.4, 59 patients; HES 200/0.5, 58 patients) who completed the study according to protocol were analyzed. The median volumes of HES administered were 49 and 33 ml/kg in the HES 130/0.4 and HES 200/0.5 groups, respectively (P < 0.001). Consequently, patients in the HES 130/0.4 group required less gelatin in addition to HES than those in the HES 200/0.5 group (medians: 7 ml/kg vs. 20 ml/kg, P < 0.001). The combined volumes of HES and gelatin were similar for both groups (P = 0.21). The 24-h chest tube drainage (medians: 660 ml vs. 705 ml, P = 0.60) did not differ significantly between the groups, nor did transfusion outcome.