急性等容血液稀释对单肺通气期间机体内环境的影响

目的 观察单肺通气(one-lung ventilation,OLV)期间,急性等容血液稀释(acute normovolemic hemodilution,ANHD)对患者机体生理的影响,探讨ANHD在OLV中应用的安全性.方法 40例ASA Ⅰ～Ⅱ级择期手术且需要行OLV的患者,随机均分为试验组(H组)和对照组(R组).H组术前行ANHD(Het目标为30%),R组不进行血液稀释(HD).术中连续检测HR、BP、CVP及心输出量(CO).均于HD前(T1)、HD后30min(T2)、OLV 15 min后(T3)、OLV30 min后(T4)各时点测量动静脉血气及动脉血乳酸(Lac),并计算心脏指数(CI).结果 (1)两组各时点Na+、K+、Ca2+、pH、BE及LAC均无显著变化.(2)H组HD后CI明显增加,其增幅为27.3%,与R组同时点比较差异有显著性,OLV后CI继续增加(P<0.05).其余血流动力学指标各时点差异无显著性.结论 ANHD在OLV中安全可行,能维持血流动力学及内环境的稳态.

Effects of acute normovolemic hemodilution on plasma homeostasis during one-lung ventilation

Objective To investigate the effects of acute normovolemic hemodilution (ANHD) on plasma homeostasis during one-lung ventilation (OLV), and the safety of ANHD. Methods Forty ASA I or II patients undergoing elective thoracic surgery under OLV were randomly assigned to receive ANHD with Hct of 30% (study group) or no hemodilution (control group). ECG, BP, CVP, SaO2, and cardiac output (CO) were monitored intraoperatively. Blood gases and lactic acid levels were determined before ANHD (T1), 30 rain after ANHD (T2), 15 min after OLV (T3), and 30 min after OLV (T4); so was cardiac index. Results Values of PH and BE and levels of Na+, K+, Ca2+ and lactic acid in the two groups did not differ significantly at different time point. CO increased by 27.3% after ANHD and continued to elevate after OLV, showing a statistical difference between the two groups at different time points (P<0.05); while there were no significant differences in the other hemodynamic indicators. Conclusiona Acute normovolemic hemodilution during one-lung ventilation is safe and feasible and can maintain hemodynamics and homeostasis.