老年患者高容量血液稀释联合控制性降压对胃肠道及炎性细胞因子的影响

目的探讨6%羟乙基淀粉（HES）130/0.4高容量血液稀释（AHH）联合控制性降压（CH）对老年髋关节手术患者胃肠道及炎性细胞因子的影响。方法 40例患者随机均分为对照组（R组）和AHH+CH组（C组）两组,每组各20例,均采用全身麻醉,R组常规输入乳酸林格氏液,C组麻醉诱导后按照15mL/kg,20～30mL/min速率,输入HES 130/0.4,联合硝酸甘油CH,维持平均动脉压在65～70 mmHg。两组分别于麻醉诱导前（基础值,T₀）、血液稀释结束（T₁）、手术结束后1 h（T₂）测定动脉血pH、血乳酸、碱剩余、肿瘤坏死因子（TNF-α）、白细胞介素-6（IL-6）和胃黏膜pH。监测心率、平均动脉压、中心静脉压、心电图、脉搏血氧饱和度,记录术中的出血量和输血量。结果与R组比较,T₁、T₂时C组TNF-α、IL-6明显降低（P<0.05）;与T₀时比较,AHH后C组中心静脉压升高（P<0.05）;C组与R组在T₁时平均动脉压、中心静脉压差异有统计学意义（P<0.05）;两组间血液pH、血乳酸、碱剩余、胃黏膜pH等比较差异无统计学意义。C组术中失血量和输血量均明显少于R组（P<0.05）。结论 HES 130/0.4 AHH联合CH对老年髋关节手术患者胃肠道影响较小,同时可降低机体的炎性反应。

Effects of acute hypervolemic hemodilution combined with controlled hypotension on stomach and bowel and inflammatory cytokine in elderly patients

Objective To investigate the effect of acute hypervolemic hemodilution（AHH） combined with controlled hypotension（CH） on stomach and bowel and inflammatory response in elderly patients undergoing total hip replacement.Methods 40 patients scheduled for elective total hip replacement were randomly divided into group R（control group） and group C（AHH combined CH） with 20 patients each.All patients were carried general anesthesia.The patients in group R received lactated Ringer’s solution after anesthesia induction.The patients in group C received 6%hydroxyethy/starch（HES） 130/0.4 15 mL/kg,20～30 mL/min after anesthesia induction,and the patients in group C were infused with nitroglycerol simultaneously to maintain mean arterial pressure at 60～70 mmHg.Heart rate,mean arterial pressure,central venous pressure,oxyhenoglobin saturation and electrocardiogram were continuously monitored throughout operation.Arterial and central venous blood samples were taken to determine pH,blood lactic acid,base excess,tumor necrosis factor-α（TNF-α）,interleukin-6,gastric mucosa pH at T₀ （baseline）,T₁（after AHH）,T₂（one hour after the end of the operation） respectively.The volume of blood loss and transfusion were recorded during operation for all patients.Results Compared to To,the TNF-α,interleukin-6 increased significantly（P <0.05） in group R;compared to group C,TNF-αand interleukin-6 of group R increased significantly at T₁ and T₂（P <0.05）.Central venous pressure was significantly higher at T₁ than at T₀ in group C（P <0.05）.Blood pH,blood lactic acid,base excess and gastric pH had on significant differences between two groups.The volume of blood loss and blood transfusion in group C were significantly less than that in group R（P <0.05）.Conclusion AHH with HES 130/0.4 combined with CH has no obvious influence on stomach and bowel in elderly patients undergoing total hip replacement and it can attenuate the inflammatory response.