全麻诱导前预充晶体胶体混合液对循环的影响

目的评价消化道肿瘤手术患者全麻诱导前预充晶体胶体混合液对诱导期循环的影响。方法拟行消化道肿瘤手术患者60例,ASAⅠ~Ⅱ级,年龄40~65岁,体质量(67±19)kg,身高(165±21)cm。随机分为3组(n=20),Ⅰ组全麻诱导前30min经中心静脉预充乳酸钠林格液15mL/kg,Ⅱ组预充6%羟乙基淀粉130/0.415mL/kg,Ⅲ组预充乳酸钠林格液和6%羟乙基淀粉130/0.4混合液15mL/kg。记录患者入室平静后(基础状态T0)、输液结束后(T1)、诱导后即刻(T2)、插管后即刻(T3)、插管后15min(T4),MAP、DBP、HR、CVP,监测T0、T1Hct和Hb。结果 3组MAP、DBP、HRT0时组间、组内比较差异无统计学意义(P>0.05),Ⅱ组T1、T2、T3、T4时CVP与Ⅰ、Ⅲ组同时点比较差异有统计学意义(P<0.05),Ⅰ组T4时CVP与Ⅱ、Ⅲ组同时点比较差异有统计学意义(P<0.05),与本组基础值比较差异无统计学意义。3组Hct和HbT0、T1时组间比较差异无统计学意义,组内比较差异有统计学意义(P<0.05)。Ⅰ组MAP<70mmHg或DBP<60mmHg总例数4例,Ⅱ组0例,Ⅲ组1例,组间比较差异无统计学意义。结论全麻诱导前预充乳酸钠林格液、6%羟乙基淀粉130/0.4或乳酸钠林格液和6%羟乙基淀粉130/0.4混合液能预防低血压的发生,保持循环的稳定,而预充一定量的晶体胶体混合液更符合生理要求,其扩容效果确切。

The Effects of Preload Crystal-colloid Mixtures before General Anesthesia induction on Circulatory System

Objective To evaluate the effects of preload lactate Ringer＇s solution and 6% hydroxyethyl starch 130/0.4 mixed liquid before induction of general anesthesia on circulatory system in patients undergoing Gastrointestinal cancer operation. Methods Sixty ASA ⅠorⅡ patients, aged 40～65 year, weighing （67±19）kg undergoing gastrointestinal cancer operation were randomly divided into three groups（n=20 each） , （group Ⅰ） the patients were infused through the central venous lactate Ringer＇s solution alone 15mL/kg in 30min before anesthesia induction,（group Ⅱ） 6% hydroxyethyl starch alone 15mL/kg, （group Ⅲ） lactate Ringer＇s solution and 6% hydroxyethyl starch 130/0.4 mixed liquid 15mL/kg. MAP, DBP, HR, CVP was measured when patient is quiet in the operation room（baseline T0）, after the infusion（T1）, after the induction（T2）, after the intubation（T3） and 15 minute after intubation. The patients＇ Hct and Hb was Measured at T0 and T1. Results MAP, DBP, HR in the three groups at T0 show no difference （P〉0.05）; CVP at T1, T2, T3, T4 in groupⅡ had statistically signifi cant from groupⅠand groupⅢ （P〈0.05）; CVP at T4 in group Ⅱhad statistically signifi cant from groupⅠand group Ⅲ（P〈0.05）, had no statistically signifi cant from its＇ baseline value. Hct and Hb show no difference at T0 and T1 compared with each group, but have statistically signifi cant in each group（P〈0.05）. MAP〈70mmHg or DBP〈60 mmHg, group Ⅰ had four, groupⅡ had zero, groupⅢ had one, There were no statistical signifi cance （P〉0.05）. Conclusion Preload lactate Ringer＇s solution, 6% hydroxyethyl starch 130/0.4 or lactate Ringer＇s solution and 6% hydroxyethyl starch 130/0.4 mixed liquid may prevent the occurrence of hypotension, maintain the stability of circulatory system. It＇s more conducive to the physiological requirements by preloading lactate Ringer＇s solution and 6% hydroxyethyl starch 130/0.4 mixed liquid , and the effects of expansion of blood volume is more exact.