雷米芬太尼对腹腔镜胆囊切除术患者IL-6、IL-8和IL-10的影响

目的观察全麻下雷米芬太尼与芬太尼对腹腔镜胆囊切除术(LC)患者白细胞介素(IL)-6、IL-8和IL-10的影响。方法20例LC患者,随机分为两组,每组10例。雷米芬太尼组(Ⅰ组)和芬太尼组(Ⅱ组),分别测定麻醉诱导前、气腹手术前、气腹手术后0.5h、术毕0.5h、术后24h的血清IL-6、IL-8和IL-10的水平。结果IL-6、IL-8和IL-10在创伤后1~1.5h开始升高,IL-6的变化最早,IL-8、IL-10在手术结束时逐渐升高,IL-6、IL-8在术后24h仍在继续上升(P<0.05),而IL-10则有不升或缓升趋势。IL-10对IL-6和IL-8的升高有一定的平衡作用。组间比较,术后24hⅠ组IL-6、IL-8较Ⅱ组都有明显升高(P<0.01)。结论与芬太尼相比,雷米芬太尼可更为有效地减轻创伤刺激后IL-6、IL-8和IL-10的释放。     

连续性血液透析滤过对MODS犬肝肾IL-6和IL-10 mRNA表达的影响

目的：探讨连续性血液透析滤过（CVVHDF）后多器官功能障碍综合征（MODS）犬肝、肾组织白细胞介素-6（IL-6）和白细胞介素-10（IL-10）mRNA表达水平的变化及意义。方法：15只雄性Beagle犬,采用失血性休克＋复苏灌注＋内毒素血症复制MODS模型,随机分为CVVHDF组（n=8）和MODS组（n=7）,CVVHDF组在内毒素注射完毕后给予CVVHDF治疗12h,MODS组不给CVVHDF治疗。测定各器官功能相关指标,同时应用半定量逆转录-聚合酶链反应（RT-PCR）测定两组肝、肾组织中IL-6、IL-10mRNA表达水平。结果：CVVHDF组治疗后肝、肾功能有关指标水平均有不同程度的改善;与MODS组相比,在内毒素注射后3h及以后各时间点,血清肌酐（Scr）、尿素氮（BUN）水平显著降低（P〈0.05）;器官衰竭发生率较MODS组明显降低（37.5%vs85.7%,P〈0.05）;MODS组肝、肾组织IL-6mRNA表达水平显著高于正常对照组和CVVHDF组（P〈0.01）,而CVVHDF组肝、肾组织IL-10 mRNA表达水平显著高于正常对照组和MODS组（P〈0.01）。结论：连续性血液透析滤过能明显改善肾功能,CVVHDF早期应用可以降低MODS肝、肾组织IL-6/IL-10mRNA比值,有助于重建机体免疫系统内稳状态。     

腹腔镜和开腹胆囊切除术对患者血清细胞因子IL-6、IL-10和IL-18的影响

目的:探讨腹腔镜胆囊切除术(LC)和开腹胆囊切除术(OC)对慢性结石性胆囊炎患者血清IL-6、IL-10和IL-18影响,比较两种方法对机体肝功能的损伤和机制。方法:选择LC患者和OC患者各30例,分别于术前、术后1d、5d抽取静脉血测定血清ALT、AST、IL-6、IL-10和IL-18含量,并进行对比研究。结果:LC组和OC组术后血清ALT、AST、IL-6和IL-18含量均较术前增加(P<0.01),血清IL-10含量较术前降低(P<0.01),上述指标术后1d变化最为明显,LC组上述血清指标变化小于同期OC组(P<0.05)。结论:LC对患者肝功能损伤较OC小,可能与LC刺激机体产生IL-6和IL-18较少,维持较高血清IL-10水平,维护适度机体细胞因子平衡有关。     

6%羟乙基淀粉对脓毒血症大鼠血浆白介素-10浓度的影响

白细胞介素(IL)-10是主要的抗炎性细胞因子之一．对全身炎症反应综合症(SIRS)／代偿性抗炎反应综合症(CANS)的平衡具有双向调节作用，6％羟乙基淀粉(HAES，200／0．5)等容血液稀释可有效地抑制因外科手术刺激所致的循环中细胞因子IL-6、IL-8水平的升高。但有关6％HAES对脓毒血症机体IL-10的影响尚未定论。本研究拟评价6％HAES对早期脓毒血症大鼠血浆IL-10浓度的影响。     

清炎颗粒对肾盂肾炎小鼠外周血IL-8与IL-10的影响

目的：探讨清炎颗粒治疗肾盂肾炎的免疫学机制。方法：采用孙氏方法改进造模,治疗组分别按剂量3.12、6.24、12.48g·kg^-1·d^-1予清炎颗粒,模型组予生理盐水,对照组予至灵胶囊灌胃,喂养至3d、7d、15d、30d、60d取血清,用ELISA法检测其IL-8、IL-10的水平。结果：清炎颗粒能显著降低不同时段血清IL-8的水平、提高不同时段血清IL-10的水平。结论：免疫调控可能是清炎颗粒治疗肾盂肾炎的作用机制之一。     

围术期镇痛对IL-6/IL-10平衡的影响

细胞因子在围术期内环境的改变中起重要作用。既往的研究集中在手术和麻醉对促炎性细胞因子的影响上,围术期镇痛对促/抑炎性细胞因子平衡的影响尚无报道,该实验对此作了初步的探索。材料和方法 动物模型和分组 Wistar大鼠,雌性,体重200-250g,以1％水合氯醛(30mg/kg)腹腔注射麻醉,折断右下肢造成完     

食管癌手术患者围术期IL-6、IL-8、IL-10的变化与术后并发症的关系

目的 研究开胸食管癌手术患者围术期的细胞因子变化与术后并发症的关系。方法择期食管癌手术患者25例,按有无并发症发生分为A、B两组。B组入选患者包括肺部感染2例、胸腔积液3例、吻合口出血1例、心律失常2例。监测麻醉前（T0）、手术开始切皮时（T1）、进胸后2h（T2）、鼓肺后 60min（T3）、术后 1h（T4）、术后 6h（T5）、术后24h（T6）血清IL-6、IL-8、IL-10的浓度。观察围术期血流动力学变化及全身性炎症反应综合征（SIRS）的持续时间（SIRS为ACCP/SCCM标准）。结果 两组患者围术期的血液动力学变化相似,SIRS持续时间A组少于B组。进胸后各时点IL-6、IL-8、IL-10均较术前显著增加（P<0.01）,T4达到高峰后回落;IL-6组间T2-T5比较无显著差异,T6B组较A组明显上升（P<0.01）,B组IL-8T3至 T6均较A组显著上升（P<0.05或0.01）。IL-10的变化趋势与IL-6、IL-8一致,在T4达到峰值后回落,B组术中各时点IL-10水平与A组比较无显著性差异,T6时低于A组。A组IL-6/IL-10、IL-8/IL-10比值在T5、T6时显著低于B组（P<0.01）。结论 开胸食管癌手术患者术后并发症的发生,不仅是由于炎症介质的大量产生,更在于抗炎性介质的不足。围术期IL-6/IL-10、IL-8/IL-10比值对于判断预后具有一定的价值。     

不同血浆代用品等容血液稀释对全脑缺血再灌注大鼠脑组织肿瘤坏死因子-α、白细胞介素-1表达的影响

目的研究不同血浆代用品血液稀释对等容血液稀释对全脑缺血再灌注大鼠脑组织肿瘤坏死因子-α(TNE-α)和白介素-1(IL-1)表达的影响。方法116只雄性Wistar大鼠随机分为假手术组(S组,n=20)、缺血再灌注组(I组,n=32)、6％羟乙基淀粉溶液血液稀释组(H组,n=32)和明胶溶液血液稀释组(G组,n=32),其中I组、H组和G组又各分为缺血10min再灌注1、3、6、12h4个亚组。分别采用MTT生物活性测定法和放射免疫分析技术检测脑组织IL-1和TNF-α含量。结果I组、H组和G组再灌注1、3、6和12h脑组织IL-1和TNF-α含量均较高于S组(P<0.01),H组再灌注3、6和12h脑组织IL-1和TNF-α含量均低于I组和G组(P<0.05)。结论脑缺血再灌注早期应用6％羟乙基淀粉血液稀释治疗可降低脑组织TNF-α、IL-1的表达。     

急性高容量血液稀释对血液动力学及血液流变学的影响

目的探讨不同速率输注6%羟乙基淀粉(HES)进行急性高容量血液稀释(AHH)对血液动力学及血液流变学的影响.方法20例ASAⅠ级的吸入全麻患者分为2组,每组10例.输注速率Ⅰ组10ml@kg@h-1,Ⅱ组20ml@kg-1@h-1.监测Ⅱ导联ECG、HR、SP、MAP、DP、CO、CI、CVP、PAP、PCWP、SpO2、PETCO2以及N2O和异氟醚呼末浓度,并行动脉血气分析和血液流变学检查.结果输注HES30和60min时,Ⅱ组HR降幅与Ⅰ组降幅比较无显著性差异(P＞0.05).Ⅰ组和Ⅱ组CI增幅基本相同(P＞0.05).60min时Ⅰ组动脉血压稍有升高,而Ⅱ组呈下降趋势(P＜0.05).输注期间2组CVP、PAP和PCWP均明显升高,60min时的升幅比30min时更大(P＜0.05);Hct、血沉方程K值和Hb浓度均明显下降,60min时降幅比30min时更大(P＜0.05).结论增加HES输注量,提高输注速率能有效加快血液扩容、稀释,但血液动力学受影响程度将加重.手术期间有血容量下降的情况下,以20ml@kg-1@h-1速率输注HES是安全的.     

羟乙基淀粉130/0.4和琥珀酰明胶对SICU患者毛细血管通透性及炎性反应的影响

目的研究羟乙基淀粉130/0.4和琥珀酰明胶对SICU患者毛细血管通透性及炎性反应的影响。方法全麻下行胸腔或腹部手术、失血量超过400ml、术后即入SICU患者100例,年龄50～64岁,体重50～75kg,ASAⅡ级,随机分成5组,每组20例,各组术中分别静脉输注羟乙基淀粉130/0.4 500ml或1 000ml,琥珀酰明胶500ml或1 000ml及乳酸钠林格氏液10ml·kg~(-1)·h~(-1),术后收入SICU。分别于术前、术后入SICU 6h时留取尿液标本,采用ELISA法测定尿白蛋白浓度,酶比色法测定尿肌酐;计算尿白蛋白/尿肌酐比值(MA/CR);抽取10ml深静脉血,采用ELISA法测定血浆IL-6浓度。结果术中静脉输注羟乙基淀粉130/0.4和琥珀酰明胶的MA/CR较静脉输注乳酸钠林格氏液降低(P<0.05);术中输注相同容积羟乙基淀粉和琥珀酰明胶的MA/CR差异无统计学意义(P>0.05);各组入SICU6h时血浆IL-6水平较术前明显升高(P<0.05),5组血浆IL-6水平差异有统计学意义,其中术中静脉输注羟乙基淀粉的最低(P<0.05)。结论静脉输注羟乙基淀粉130/0.4或琥珀酰明胶500 ml有助于改善SICU患者毛细血管的通透性,而羟乙基淀粉130/0.4的抗炎作用明显优于琥珀酰明胶。     

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.     

急性高容血液稀释对老年心脏手术病人脑氧合功能的影响

目的　观察急性高容性血液稀释 (AHHD)对老年心脏手术病人脑氧合功能的影响并探讨其可能的作用机制。方法　 2 4例冠状动脉搭桥术 (CABG)的病人 ,ASAⅠ～Ⅱ级 ,随机分为老年扩容组、未扩容组和中青年扩容组。扩容组诱导时 1小时内经颈内静脉推注 6 %贺斯溶液 1 0ml/kg ,同时静注硝酸甘油 0 5μg·kg- 1 ·min- 1 。分别于术前、诱导后 5分钟、扩容止及主动脉插管时监测血液动力学指标 ,测定动、静脉血乳酸浓度 ,脑血氧饱和度 (SjvO2 ) ,脑血氧分压 (PjO2 )和脑血流速率。结果　 (1 )老年扩容组的PAP较术前显著增高 (P <0 0 5) ,但与其他两组相比无显著差异。 (2 )未扩容组的SjvO2 ,CBF/CMRO2 在主动脉插管时较术前显著降低 (P <0 0 1 ) ,与扩容组相比也显著减少 (P<0 0 5) ;而老年扩容组SjvO2 较术前及另外两组均显著增加 (P <0 0 5) ,CBF/CMRO2 无明显变化。(3)脑血流速率在中青年扩容组病人均显著高于另外两组 (P <0 0 5)。 (4)脑乳酸净生成量 (ADVL)三组间无显著差异 (P >0 0 5)。结论　AHHD对老年手术病人脑氧合功能具有一定的保护作用。     

急性高容量血液稀释对全麻患者顺式阿曲库铵药效学的影响

目的 探讨急性高容量血液稀释(AHH)对全麻患者顺式阿曲库铵药效学的影响.方法 择期腹部手术患者印例,年龄18～60岁,ASAI或Ⅱ级,随机分为对照组(C组)和AHH组,每组30例,各组按顺式阿曲库铵首剂量(首剂量分别为30、40、50μg/kg,总用量100 μg/kg)分为3个亚组,每亚组10例.采用TOF-Wateh~(R)SX肌松监测仪监测神经肌肉阻滞情况.AHH组经30～40 min静脉输注6%羟乙基淀粉130/0.4 15 ml/kg行血液稀释,AHH后各亚组分别给予首剂量顺式阿曲库铵,当T_1达最大抑制后再注入余量.记录肌松起效时间、临床肌松作用时间、体内作用时间及恢复指数.采用概率单位法计算T_1抑制50%、90%、95%时顺式阿曲库铵的用量(ED_(50)、ED_(90)、ED_(95).结果 与C组比较,AHH组顺式阿曲库铵ED_(50)、ED_(90)、ED_(95)升高,肌松起效时间延长,临床肌松作用时间及体内作用时间缩短(P<0.05或0.01),恢复指数差异无统计学意义(P>0.05).结论 AHH可降低顺式阿曲库铵的肌松效应.     

羟乙基淀粉术前急性高容量血液稀释在肺癌手术中的应用

目的观察羟乙基淀粉(HES)术前急性高容量血液稀释(AHH)在全麻复合硬膜外阻滞下肺癌手术患者中应用的可行性。方法ASAⅠ~Ⅱ级患者42例,随机分为观察组(V组)和对照组(C组)。V组:于切皮前50ml/min输入6%HES130/0·41000ml。C组:输注等量复方氯化钠。持续监测MAP、HR、SpO2和PETCO2。分别于稀释前、稀释后、术毕、术后第1天和第7天测定红细胞压积(Hct)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)和纤维蛋白原浓度(Fib)的变化;记录术中输血量和输液量;计算出血量。结果术中两组患者出血量和输液量差异无显著意义,输血量及输血患者人数V组明显低于C组(P<0·05)。V组MAP的变化明显低于C组(P<0·05),稀释后,HR明显减慢(P<0·05),CVP明显升高(P<0·01),但尚在正常生理范围。V组的Hct在稀释后及术中明显低于基础值及C组(P<0·05),但在术毕和术后第1天及第7天两组间差异无显著意义。PT、APTT及Fib组间比较差异均无显著意义。结论全麻复合硬膜外阻滞下肺癌手术患者使用HES施行AHH可有效维持血液动力学平稳及提高患者对失血的耐受性。     

高容量血液稀释对全髋置换术病人异丙酚药代动力学的影响

目的观察高容量血液稀释(HHD)对全髋置换术病人异丙酚药代动力学的影响。方法择期行全髋置换术病人16例,ASAⅠ或Ⅱ级,年龄20～55岁,随机分为2组(n=8)：常规补液组(C 组)和 HHD 组(H 组),入室后均输入乳酸林格氏液(术前禁食量,h 为术前禁食时间)0.7ml·kg~(-1)·h~(-1) 后,C 组按常规补液方案补充手术需要量；H 组以20ml·kg~(-1)·h~(-1)速率输入4%琥珀酰明胶20ml·kg~(-1) 实施 HHD,目标红细胞压积30%。静脉注射咪唑安定0.04mg·kg~(-1)、芬太尼4μg·kg~(-1)、异丙酚1.5 mg·kg~(-1)及琥珀胆碱2mg·kg~(-1)麻醉诱导后气管内插管,分别于注射异丙酚后1、2、4、6、10、15、30、45、 60、75、90、120、150、180、240、300、360min 经颈内静脉采血,用反向高效液相色谱荧光法测定血浆异丙酚浓度,用3P97药代动力学软件进行药代学数据分析。结果与 C 组比较,H 组注射异丙酚后1～10 min 异丙酚血药浓度降低(P＜0.01),注射异丙酚后15～360min 异丙酚血药浓度差异无统计学意义。异丙酚药代动力学特征符合药代动力学三室开放模型,与 C 组比较,H 组中央室分布容积增加,消除相半衰期延长,K_(10)和全身清除率降低(P＜0.01或0.05),快速分布相半衰期、慢分布相半衰期、K_(12)、 K_(21)、K_(13)、K_(31)、曲线下面积差异无统计学意义。结论 HHD 提高了异丙酚的中央室分布容积,降低了 K_(10)和全身清除率,延长了消除相半衰期,可能导致药效增强。     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

目的 探讨不同液体术前急性高容量血液稀释(AHH)对深静脉血栓病人血液流变学的影响.方法 拟行股静脉取栓术病人30例,年龄40～64岁,栓塞时问<48 h,随机分为3组(n=10):生理盐水组(NS组)、羟乙基淀粉组(HES组)和琥珀酰明胶组(GEL组).麻醉诱导前分别静脉输注生理盐水、6%羟乙基淀粉(HES,200/0.5)或琥珀酰明胶40 min,输注速率20 ml·kg-1·h-1.分别于AHH 前、后即刻采集静脉血样5 ml,测定全血粘度高切变率、全血粘度低切变率、血浆粘度、红细胞压积、红细胞聚集指数和变形指数,并记录MAP、HR和SpO2.记录术中输液量和输血量.结果 AHH前、后三组血液动力学指标均在正常范围内.与NS组比较,HES组AHH后即刻全血粘度高切变率、全血牯度低切变率和红细胞聚集指数降低,血浆粘度和红细胞变形指数升高,GEL组AHH后即刻全血粘度高切变率和低切变率降低,血浆粘度升高(P<0.05或0.01);与HES组比较,GEL组全血粘度低切变率、红细胞聚集指数升高,红细胞变形指数降低(P<0.01).结论 6%羟乙基淀粉(200/0.5)和琥珀酰明胶术前AHH改善深静脉血栓病人血液流变学状态的效果优于生理盐水,且6%羟乙基淀粉的效果更优,可改善该类病人血液流动缓慢和血液高凝状态,降低了再次发生血栓的危险.＃     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.