6%羟乙基淀粉液和乳酸复方氯化钠注射液急性高容量血液稀释在皮瓣移植术中的应用

目的观察急性高容量血液稀释（AHH）用于皮瓣移植术后对血流动力学的影响，为节约用血、提高皮瓣存活率选择合理的血液代用品提供依据。方法50例行股前外侧皮瓣移植手术病人，随机分成两组，每组25例，以50ml／min的速率分别输注6％羟乙基淀粉液（H组）和乳酸复方氯化钠注射液（R组），扩容量为20ml／kg。监测稀释前后心率（HR）、中心静脉压（CVP）、平均动脉压（MAP）、红细胞比容（Hct），并记录失血量、尿量、输血量及总输液量。结果高容量血液稀释后两组的CVP、MAP均比稀释前增高，心率减慢，Hct明显降低（P〈0．05），但都在正常范围内。R组尿量和总输液量明显高于H组（P〈0．05）。稀释后2hR组的CVP、MAP明显低于H组（P〈0．05）：术后两组移植皮瓣均存活。结论术前行AHH，不但可以减少输血、节约用血，而且对血流动力学及血液流变学的影响有助于提高皮瓣移植术的成功率：

Application of acute hypervolemic hemodilution with hydroxyethyl starch and ringer's solution on skin flap grafting

Objective To observe the hemodynamic effects of acute hypervolemic hemodilution(AHH)used in skin flap grafting.To provide the evidences of using reasonable plasma substitutes of blood transfusion and elevating the survival rate of skin flap grafting.Methods50pa-tients undergoing anterior-lateral femoral skin flap grafting were randomized to two groups.Each group had25patients.The patients were re-spectively treated with6%HES(H group)or Ringer's solution(R group)for AHH with dose of20ml/kg,infusion rate of50ml/min.The data of HR,CVP,MAP and Hct before and after AHH were monitored.The amount of hemorrhage,urine volume,the amount of blood transfusion and the total solution volume were recorded.Results CVP and MAP after AHH were higher than those before AHH in both groups.HR decreased and Hct decreased apparently(P<0.05).But all of them were in normal range.Urine volume and the total solution volume in R group were obviously higher than those in H group(P<0.05).Inducing AHH two hours later,CVP,MAP in R group were apparently lower than those in H group(P<0.05).The skin flaps of both groups were survivable after operations.Conclusion Using AHH before operations can reduce the amount of blood transfusion,reserve blood resources.It can also elevate the survival rate of skin flap grafting through changing hemodynamics and hemorheologics.