6％羟乙基淀粉行急性超容血液稀释对血电解质及酸碱平衡的影响

目的探讨6％羟乙基淀粉溶液（HES，200／0．5）行急性超容血液稀释（AHHD）对机体血电解质及酸碱平衡的影响。方法选择20例20—40岁、ASAⅠ～Ⅱ级择期五官科手术插管全麻患者，以6％HES15ml／kg扩容行中度血液稀释。于AHHD前、AHHD后、手术结束时测定Het、Hb、血电解质及酸碱平衡指标进行比较。结果AHHD后、手术结束时Hct、Hb较AHHD前显著降低，AHHD后Hct、Hb分别下降了23．1％和21．4％，达到中等程度血液稀释状态；AHHD后血K^＋浓度下降了13．65％，血Ca^2＋浓度也明显下降了39．80％．但均在正常范、围内；AHHD前、后pH值及血Na^＋浓度变化差异均无统计学意义。结论6％HES溶液行AHHD能有效地使Hct及Hb下降至靶水平．同时维持了机体血电解质的稳定及酸碱平衡，是一种安全有效的AHHD方法。

Effect of Acute Hypervolemic Hemodilution by 6 % of HES on Blood Electrolytes and Acid-base Balance

Objective To investigate the effect of acute hypervolemic hemodilution （AHHD） with 6% of HES on blood electrolytes and acid - base balance. Methods Twenty patients （ ASA Ⅰ - Ⅱ , 20 -40 years old） were selected and scheduled for ophthalmologic and otorhinolaryngologic operation under general anesthesia. They received 6% of HES （15ml/kg） for moderate hemedilution. Arterial blood samples were taken for determination of HCT, Hb, K ^＋ , Na ^＋, Ca^2＋ and pH before and after AHHD, and at the end of surgical operation. Results HCT and Hb significantly decreased after AHHD. HCT and Hb descended respectively by 23.1% and 21.4%, which reached the state of moderate hemodilution. K^＋ and Ca^2 ＋ after AHHD were decreased by 13.65% and 39.80%, respectively, but within mormal limits. The variation of pH and Na ^＋ before and after AHHD had no statistic difference. Conclusion AHHD with 6% of HES can make HCT and Hb decrease to target level effectively, while maintaining the blood electrolyte and acid - base balance, it is a safety and effect method for hemodilution.