麻醉诱导时快速扩容对胃肠道手术患者血流动力学和氧平衡的影响。
Effect of rapid plasma volume expansion during anesthesia induction on haemodynamics and oxygen balance in patients undergoing gastrointestinal surgery.
机构信息
Department of Anaesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
出版信息
Int J Med Sci. 2013;10(4):355-61. doi: 10.7150/ijms.5294. Epub 2013 Feb 15.
AIMS
To investigate the reasonable dose of Voluven for rapid plasma volume expansion during the anaesthesia induction patients receiving gastrointestinal surgery.
METHODS
Sixty patients were randomly divided into three groups (n=20): Group A (5 ml/kg), Group B (7 ml/kg) and Group C (9 ml/kg). HES 130/0.4 was intravenously transfused at a rate of 0.3 ml/kg/min) at 30 min before anaesthesia induction. Besides standard haemodynamic monitoring, cardiac index (CI), systemic vascular resistance index (SVRI) and stroke volume variation (SVV) was continuously detected with the FloTrac/Vigileo system. Haemodynamic variables were recorded immediately before fluid transfusion (T0), immediately before induction (T1), immediately before intubation (T2), immediately after intubation (T3) and 5 min, 10 min, 20 min and 60 min after intubation (T4-T7). Arterial and venous blood was collected for blood gas analysis, Hb and Hct before volume expansion (t0), immediately after volume expansion (t1) and at 1 h after volume expansion (t2). Oxygen delivery (DO2), oxygen extraction ratio (ERO2) and volume expansion rate were calculated.
RESULTS
- MAP and CI decreased in Group A in T2
T7 and remained changed in Group B and C. 2) CVP increased in three groups after fluid infusion without significant difference. 3) The decrease in SVRI was more obvious in Group B and C than that in Group A after induction and more obvious in Group C than in Group B in T2-T4 and T6T7. 4) SVV was lower in Group B and C than that in Group A after intubation, and lower in Group C than that in Group B in T3-T6. 5) Hb and Hct decreased after fluid infusion, and the decrease in Hb and Hct was in the order of C>B>A. 6) Volume expansion rate was in the order of C>B>A. 7) ScvO2, PaO2 and DO2 increased in three groups after fluid infusion and the increase in DO2 was in the order of C>B>A.
CONCLUSIONS
Rapid plasma volume expansion with Voluven at 7-9 ml/kg can prevent haemodynamic fluctuation during anaesthesia induction, maintain the balance between oxygen supply and oxygen consumption during gastrointestinal surgery, and Voluven at 9 ml/kg can improve the oxygen delivery.
目的
研究胃肠道手术患者麻醉诱导期间快速扩容使用万汶的合理剂量。
方法
60 例患者随机分为三组（每组 20 例）：A 组（5ml/kg）、B 组（7ml/kg）和 C 组（9ml/kg）。在麻醉诱导前 30min 以 0.3ml/kg/min 的速度静脉输注 HES130/0.4。除标准血流动力学监测外，还连续使用 FloTrac/Vigileo 系统检测心指数（CI）、全身血管阻力指数（SVRI）和每搏量变异（SVV）。在输液前即刻（T0）、诱导前即刻（T1）、插管前即刻（T2）、插管后即刻（T3）以及插管后 5min、10min、20min 和 60min（T4-T7）时记录血流动力学变量。在容量扩张前（t0）、容量扩张后即刻（t1）和容量扩张后 1h（t2）时采集动脉和静脉血进行血气分析、Hb 和 Hct。计算氧输送（DO2）、氧摄取率（ERO2）和容量扩张率。
结果
1）A 组在 T2-T7 时 MAP 和 CI 降低，B 组和 C 组持续变化。2）三组输液后 CVP 升高，无显著差异。3）诱导后 B 组和 C 组 SVRI 下降较 A 组更明显，T2-T4 和 T6-T7 时 C 组较 B 组更明显。4）插管后 B 组和 C 组 SVV 较 A 组降低，T3-T6 时 C 组较 B 组降低。5）输液后 Hb 和 Hct 降低，Hb 和 Hct 降低程度为 C>B>A。6）容量扩张率为 C>B>A。7）三组输液后 ScvO2、PaO2 和 DO2 升高，DO2 升高程度为 C>B>A。
结论
万汶快速扩容 7-9ml/kg 可预防麻醉诱导期间血流动力学波动，维持胃肠道手术期间氧供与氧耗平衡，9ml/kg 万汶可提高氧输送。
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