不同民族围术期血液稀释期间靶控输注异丙酚的可行性分析

目的 观察新疆地区不同民族病人急性等容血液稀释(ANHD)期间靶控输注(TCI)异丙酚血药浓度及血液动力学的变化,并探讨在新疆地区行ANHD的可行性.方法 选择15例ASAⅠ~Ⅱ级全麻下择期行非心脏手术的病人,维吾尔族8例(Ⅰ组),汉族7例(Ⅱ组).全麻后施行ANHD,血液稀释完成10 min后,以恒定靶血浆药物浓度(3 μg/mL)变速输注异丙酚60 min,间断采血180 min,应用气相色谱-质谱法测定异丙酚血药浓度.结果 (1)ANHD后两组病人红细胞压积(Hct)由(40.0±4.2)%和(39.7±3.9)%分别下降至(26.1±2.3)%和(25.0±1.6)%;血红蛋白(Hb)由(134.8±13.4) g/L和(135.7±13.8) g/L分别下降至(90.0±9.3) g/L和(82.9±7.6) g/L.Hct、Hb下降幅度两组间比较差异无统计学意义.(2)两组病人ANHD前后心率(HR)、收缩压(SBP)、舒张压(DBP)无显著变化.(3)TCI异丙酚期间两组病人实测血药浓度之间及每组病人各时点靶浓度与实测浓度的比较,差异均无统计学意义.结论 在新疆地区维吾尔族成年病人以6%羟乙基淀粉溶液及林格氏液行ANHD安全可行,且对ANHD期间TCI异丙酚血药浓度没有影响.

Feasibility analysis of target-controlled infusion by propofol during perioperative hemodilution in different nationalities

Objective To investigate the changes in propofol blood concentration and hemodynamics in different races when propofol was infused by target-controlled infusing pump during acute normovolemic hemodilution(ANHD),and the feasibility of performing ANHD in Xinjiang.Methods Fifteen ASA Ⅰ-Ⅱ patients,aged between 20-60 years old,undergoing elective non-cardiac surgery under general anesthesia,were allocated randomly into two groups: group Ⅰ(Uyghur nationality,n=8) and group Ⅱ(Han nationality,n=7).ANHD was performed after induction of general anesthesia.Ten minutes after ANHD,TCI of propofol with concentration of 3 μg/mL was started,it continued for 60 minutes.Intermittent blood collection was taken for 180 min,Blood concentration of propofol was tested by gas-chromatography-mass spectrometry(GC-MS).Results(1) After ANHD,Hct of two group′ patiehts decreased from(40.0±4.2)% and(39.7±3.9)% to(26.1±2.3)% and(25.0±1.6)%,and Hb decreased from(134.8±13.4)g/L and(135.7±13.8)g/L to(90.0±9.3)g/L and(82.9±7.6)g/L,respectively.Decrease amplitude of Hct and Hb were not significant difference between two groups.(2) The changes in HR,SBP,and DBP between the two groups were not statistic significance.(3) The changes in propofol blood concentrate during target-controlled infusion in the two groups were no statistic significance.Conclusion ANHD with 6% HES and Ringer′s solution was safe in Uyghur people in Xinjiang.There was no effect of race(Uygur people and Han people) on propfol blood concentration during target-controlled infusion.