血液稀释对全麻腹腔镜活体肾移植供体围手术期血管外肺水的影响

目的：探讨高容量血液稀释（HHD）、等容量血液稀释（NHD）及常规液体输注（CIT）对全麻腹腔镜活体肾移植供体围手术期肺水的影响。方法：随机将48例健康成年志愿捐肾者分为4组：A组（n=10,对照组,乳酸钠林格氏液,CIT）,B组（n=12,4%琥珀酰明胶4～5ml/kg,NHD）、C组（n=13,4%琥珀酰明胶20ml/kg,HHD）,D组（n=13,4%琥珀酰明胶30ml/kg,HHD）,在全麻腹腔镜下行肾脏摘除手术。B、C、D组于麻醉诱导后至肾动脉阻断前静脉输注4%琥珀酰明胶4～5、20、30ml/kg稀释血液。术中监测麻醉诱导前（T0）、手术开始后30min（T1）、肾动脉阻断时（T2）、肾动脉阻断后15min（T3）、手术结束时（T4）及手术结束后240min（T5）的平均动脉压（MAP）、心率（HR）、心电图（ECG）、脉搏血氧饱和度（SpO2）、中心静脉压（CVP）等指标。于各时点抽取动、静脉血进行血气分析,应用全自动生化分析仪测定血浆胶体渗透压（PCOP）;T2、T4时分别测量供肾者胶体液总量及尿量、晶体液总量。手术期间4组以20ml/（kg.h）速率常规输注乳酸钠林格液。C、D组于大量输注琥珀酰明胶期间静脉持续输注硝酸甘油3～8μg/（kg.h）,于阻断肾动静脉后常规应用速尿40mg。结果：（1）4组ECG、SpO2、晶体液总量及围手术期总出血量等均无显著差异（P〉0.05）;（2）C、D组T1、T2、T3、T4时MAP、CVP、PCOP高于A、B组（P〈0.05）,但均在正常范围;（3）与T0相比,C、D组T2、T3时Hb、Hct降低显著（P〈0.05）,分别达中度（P〈0.05）和重度（P〈0.01）血液稀释水平;T2,T3时A、D组PaO2下降（P〈0.05）,而C组升高（P〈0.05）;（4）T4时C、D组总尿量、胶体液总量大于A、B组（P〈0.05）。结论：不同的血液稀释状态对全麻腹腔镜活体肾移植供体围手术期血管外肺水产生不同的影响,静脉输注琥珀酰明胶20ml/（kg.h）时高容量血液稀释可产生良好的扩容效果

Effects of hemodilution on extravascular lung water of living kidney transplantation donors

Objective:To investigate the effects of different hemodilution(HHD,MHD,CIT)on extravascular lung water of living kidney transplantation donors by laparoscopy under general anesthesia.Methods:Fourty-eight donors were classificated into four grous(Group A=10 cases,Group B=12 cases,Group C=Group D=13 cases)at random.Data of MAP,HR ECG,SpO2,CVP,Blood-gas analysis,PCOP were recorded in different times(T0,T1-T5).Results:(1)Four groups were similar regarding ECG,SpO2,total crystal volume,total blood loss.(2)MAP,CVP,PCOP were higher in group C and D than in group A and B at T1-T4,but they were all normal.(3)Hb,Hct decreased more significantly in group C and D at T2,3 than at T0.PaO2 decreased in group A and D at T2,T3,but it increased in group C.(4)Total urine volume and colloid volume were more in group C and D than group A and B at T4.Conclusions:The effects of hemodilution on extravascular lung water rely on the statue of hemodilution.HHD is a better selection for hemodilution and is good for protection of lung.