围术期急性高容量血液稀释对患者脑氧供需平衡的影响

目的评估围术期急性高容量血液稀释(AHH)对患者脑氧供需平衡的影响。方法选择60例预计手术出血量>600 mL患者随机分为AHH组、输血组及对照组,每组20例,其中AHH组在全身麻醉诱导后于30 min内输注60 g·L-1羟乙基淀粉15 mL·kg-1,输血组输注悬浮红细胞1²单位,对照组则于30 min内输注复方电解质溶液5 mL·kg-1,并分别于麻醉诱导前(T1)、气管插管后(T2)及输液30 min后(T3)3个时点采集颈静脉球部和桡动脉血行血气分析,比较中心静脉压(CVP)、动脉血-颈内静脉血氧含量差C(a-jv)O2]、颈静脉球血氧饱和度(SjvO2)及脑氧摄取率(CERO2)的变化。结果 T1、T2时点3组患者CVP比较差异均无统计学意义(P>0.05);AHH组及输血组T3时点的CVP较对照组升高,差异有统计学意义(P<0.05),AHH组及输血组T3时点CVP比较差异无统计学意义(P>0.05)。SjvO2、C(a-jv)O2与CERO2在T1、T2、T3时点3组间比较差异均无统计学意义(P>0.05)。结论围术期AHH不影响脑氧供需平衡;相反,AHH使血流动力学状态更稳定,在临床应用中是安全可行的。

Effect of acute hypervolemic hemodilution on cerebral oxygen balance of patients in perioperative

Objective To assess the effect of acute hypervolemic hemodilution（AHH） on cerebral oxygen balance of patients in perioperative.Methods Sixty patients with the expected amount of bleeding in surgery 600 mL were randomly divided into AHH group,blood transfusion group and control group,with twenty patients in each group.Patients in AHH group were injected with 60 g·L^-1 hydroxyethyl starch（15 mL·kg^-1） within 30 minutes after the induction of general anesthesia,while patients in blood transfusion group were treated by 1-2 U of red blood cells suspension.In addition,patients in control group were treated using electrolyte solution（5 mL·kg^-1） within 30 minutes.The jugular bulb and radial artery blood were collected at before induction of anesthesia（T1）,after tracheal intubation（T2） and after 30 minutes of infusion（T3） respectively,and then the blood gas analysis was conducted.The changes of central venous pressure（CVP）,cerebral arteriovenous oxygen content differenceC（a-jv） O2],jugular venous oxygen saturation（SjvO2） and cerebral oxygen extraction rate（CERO2）were compared among the three groups.Results There was no significant difference of CVP at T1 and T2 time point among the three groups（P〉 0.05）.The CVP at T3 in AHH group and blood transfusion group were significantly higher than those in control group（P〈 0.05）; but no significant difference was found between AHH group and blood transfusion group（P〈 0.05）.There was no significant difference of SjvO2,C（a-jv） O2and CERO2at T1,T2 and T3 among the three groups（P〈 0.05）.Conclusion AHH do not influence cerebral oxygen balance in perioperative.On the contrary,AHH can lead to more stable hemodynamic status,and it is secure and feasible in the clinical application.