急性高容血液稀释联合控制性降压对老年患者氧代谢的影响

目的探讨术前急性高容血液稀释（AHH）联合尼卡地平降压对老年患者氧代谢的影响。方法择期行肝胆肿瘤切除手术患者30例,年龄60-76岁,随机分为术前AHH联合尼卡地平降压组（AHHN组,n=15）和对照组（n=15）。于术前1h分段实施AHH,使红细胞压积（Hct）下降至28%左右。分段采集动静脉血行血气分析,测定血红蛋白（Hb）、Hct、动脉血乳酸（ABL）,并计算动脉血氧含量（CaO2）、混合静脉血氧含量（CvO2）和氧摄取率（ERO2）。结果两组患者扩容前CaO2、CvO2和ERO2差异均无统计学意义（P〉0.05）,随着血液的稀释,AH-HN组CaO2和CvO2逐渐降低,C（a-v）O2也降低,而ERO2呈增高趋势,所有病人的ABL值均无明显变化,C（a-v）O2、ERO2及ABL组间比较差异无统计学意义（P〉0.05）。结论老年患者分段实施术前AHH联合尼卡地平降压,对机体的氧代谢无明显影响,是安全可行的。

Effects of acute hypervolemic hemodilution combined controlled hypoteusion on oxygen metabolism in elderly patients

Objective To investigate effects of acute hypervolemic hemodilution（AHH） combined controlled hypotension（CH） on oxygen metabolism in elderly patients.Methods Thirty ASAⅠ-Ⅱpatients（60-76yr） scheduled for elective hepatic and gall tumor operation were randomly divided into two groups： AHH combined nicardipine（AHHN group,n=15） and control group（n=15）.Hct was decreased to 28%.MAP,HR,SPO2 and CVP were continuously monitored.AHH was induced with 6% HES at 25 ml/min before induction and before skin throughout operation.Arterial and central venous blood samples were taken for gas analysis and determination of Hb,Hct and arterial blood lactate（ABL） before（T0） and 15min after AHH（T1）,and at the end of the surgery（T2）.Arterial oxygen content（CaO2）,mixedvenous oxygen saturation（SvO2）,oxygen extraction rate（ERO2） were calculated.Results CaO2 and SvO2 were decreased significantly,but ERO2 increased significantly,ABL was not changed after AHH.There were not significantly different in（a-v）O2,ERO2 and ABL between groups.Conclusion It is safety that AHH combined controlled hypotension induced with nicardipine in elderly patients,and it can not affect oxygen metabolism.