急性高容量血液稀释联合控制性降压对老年患者心肌钙蛋白Ⅰ的影响

目的观察急性高容量血液稀释（acute hypervolemic hemodilution,AHH）及其联合控制性降压（controlled hypoten-sion,CH）对老年患者心肌钙蛋白Ⅰ（TroponinⅠ,CTnI）的影响。方法选择肝脏及胰十二指肠手术患者30例,65岁以上,美国麻醉师协会（ASA）分级Ⅱ级,随机分为两组,组Ⅰ单纯AHH,在麻醉诱导后手术开始前以30 ml/min的速率输入6%羟乙基淀粉15ml/kg,组ⅡAHH联合CH,在AHH同时以平均动脉压（mean arterial pressure,MAP）的70%为目标用尼卡地平行CH。分别于AHH前即刻（T0）、AHH完成即刻（T1）、完成后1 h（T2）、完成后2 h（T3）记录血红蛋白（hemoglobin,Hb）、血细胞比容（hemato-crit,Hct）,平均动脉压（mean arterial pressure,MAP）,中心静脉压（central venous pressure,CVP）,于T0、T1、T3、术后4 h（T4）、术后24 h（T5）测定CTnI;术毕记录手术时间、出血量、输血量。结果 （1）两组手术时间,出血量,输血量差异无统计学意义（P〉0.05）;（2）Hb、Hct：与T0相比,组Ⅰ与组Ⅱ在T1、T2、T3的Hb、Hct均下降（P〈0.05）,两组Hb、Hct在各时间点比较差异均无统计学意义（P〉0.05）。MAP、CVP：与T0相比,组Ⅰ的MAP在各时间点比较差异均无统计学意义（P〉0.05）,CVP均升高（P〈0.05）,组Ⅱ的MAP在各时间点均下降（P〈0.05）,CVP差异无统计学意义（P〉0.05）;与组Ⅰ相比,组Ⅱ的MAP与CVP均下降（P〈0.05）;（3）CTnI的变化：在组内各时点及组间相应时点差异均无统计学意义（P〉0.05）。结论对于65岁以上、ASAⅡ级,无明显心肺疾患的老年患者,单纯应用AHH及其联合尼卡地平CH对老年患者CTnⅠ无影响,不会引起心肌损伤。

Effect of acute hypervolemic hemodilution combined with controlled hypotension on troponin I in elderly patients

Objective To investigate the effect of acute hypervolemic hemodilution(AHH) or AHH combined with controlled hypotension(CH) induced by nicardipine on troponin I(CTnI) in elderly patients,and to evaluate the feasibility in clinical use.Methods This study included thirty ASA Ⅱ patients aged 65 to 79,and undergoing selective liver cancer,hepatic hemangioma or pancreas duodenum operations during which the blood loss was expected to be over 15% of the patients’ blood volume.These patients were randomly divided into two groups: group Ⅰ AHH(n=15) and group Ⅱ AHH combined with nicardipine CH(n=15).In both groups compound sodium acetate injection was infused at a rate of 10 ml/kg when the patients entered the operating room.6% hydroxyethyl starch solution(HES 200/0.5) 15 ml/kg was infused at a rate of 30 ml/min before skin incision in both groups.In group Ⅱ,nicardipine was infused at a rate of 1-4 μg/(kg·min) and MAP maintained at 70% of the preoperative level as soon as AHH began.Hematocrit(Hct),hemoglobin(Hb),MAP(mean arterial pressure),CVP(central venous pressure)were measured before AHH(T0),towards the end of AHH(T1),1h after AHH(T2) and 2 h after operation(T3).CTnI was measured at T0,T1,T3,4 h after operation(T4) and 24 h after operation(T5).During the operation,blood loss and the transfusion volume were recorded.Results(1) The two groups were comparable in the duration of operation,blood loss and transfusion volume.(2) Compared with the value at T0,Hct and Hb were decreased at T1,T2,T3 in both groups.Hct and Hb in group Ⅱ were not significantly different from those in group Ⅰ.MAP was not significantly different from the value at T0.CVP was increased in group Ⅰ while MAP was decreased and CVP was not significantly different in group Ⅱ.Compared with group Ⅰ,MAP and CVP were decreased in group Ⅱ.(3) CTnI was not significantly different during and after operation in both groups.Conclusions AHH or AHH combined with CH induced by nicardipine used for treating elderly patients without cardiac and puhnonary diseases have little influence on myocardial function.