急性超容量血液稀释对行腰椎手术患者血流动力学的影响

目的 探讨急性超容量血液稀释对俯卧位下行腰椎手术患者血流动力学的影响。方法 选择拟行腰椎手术俯卧位患者150例, 随机分为3组, 乳酸林格氏液组 (n=50) :麻醉诱导后30 min内输入乳酸林格氏液15 m L/kg;羟乙基淀粉组1 (n=50) :麻醉诱导后30 min内输入羟乙基淀粉氯化钠 (130/0.4) 15 m L/kg;羟乙基淀粉组2 (n=50) :麻醉诱导后30 min内输入羟乙基淀粉氯化钠 (130/0.4) 20 m L/kg。采用Flo Trac/Vigilo心排量监测仪, 连续监测患者每间博量指数 (SVI) 、心输出量指数 (CI) 、心脏每搏变异度 (SVV) 等各项指标;记录和分析患者仰卧位及俯卧位后平均动脉压 (MAP) 、心率 (HR) 、CI、SVI、SVV、中心静脉压 (CVP) 及气道压 (P) 。结果 和仰卧位比较, RS组患者俯卧位后10 min CI、SVI、CVP均明显降低 (P<0.05) , MAP、SVV和气道压力明显增加 (P<0.05) , HR无明显变化 (P> 0.05) ;HES1组上述各参数变化趋势和RS组一致, 但俯卧位和仰卧位之间各参数差异比RS组明显减小;HES2组俯卧位后CI、SVI、HR、SVV和仰卧位之间均无明显差异 (P> 0.05) , 俯卧位后MAP和气道压力较仰卧位明显增加 (P<0.05) 。结论 急性血液稀释 (HES 15 m L/kg和20m L/kg) 均可以改善俯卧位后血流动力学波动, HES 20 m L/kg更有利于维持俯卧位后循环稳定。

Effect of Acute Hypervolemic Hemodilution on Hemodynamics in Patients Undergoing Lumbar Surgery

Objective To investigate the effect of acute hypervolemic hemodilution on hemodynamics in patients undergoing lumbar surgery in prone position. Methods 150 patients in prone position were randomly divided into 3 groups: Ringer's lactate solution group (n=50) : Ringer's lactate solution 15 m L/kg was injected within 30 minutes after anesthesia induction; hydroxyethyl starch group 1 (n=50) ;hydroxyethyl starch sodium chloride (130/0.4) 15 ml/kg was injected within 30 minutes after anesthesia induction; hydroxyethyl starch group 2 (n=50) : after induction of anesthesia, hydroxyethyl starch sodium chloride (130/0.4) 20 ml/kg was injected into 30 min. Flo Trac/Vigilo cardiac output monitor was used to continuously monitor the patients' SVI, CI, SVV, MAP, HR, CI, SVI, CVP and CVP in supine and prone positions. Airway pressure (P) . Results Compared with the supine position, the CI, SVI and CVP in RS group decreased significantly 10 minutes after prone position (P < 0.05) , MAP, SVV and airway pressure increased significantly (P < 0.05) , HR did not change significantly (P > 0.05) ;the change trend of the above parameters in HES1 group was the same as that in RS group, but the difference of parameters between prone position and supine position was more obvious than that in RS group. There was no significant difference in CI, SVI, HR, SVV and supine position after prone position in HES2 group (P > 0.05) , MAP and airway pressure after prone position were significantly higher than those in supine position (P < 0.05) . Conclusion Acute hemodilution (HES 15 m L/kg and 20 m L/kg) can improve the hemodynamic fluctuation after prone position, and HES 20 ml/kg is more beneficial to maintain the circulation stability after prone position.