Xie Rufeng, Wang Lizhong, Bao Hongguang
Department of Anesthesiology, Nanjing First Hospital Nanjing, Jiangsu 210006, China.
J Biomed Res. 2011 May;25(3):185-90. doi: 10.1016/S1674-8301(11)60024-9.
The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output (CO) and incidence of hypotension in elderly patients under spinal anesthesia (SA). A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement (THR), who were randomized to three groups: the control group (C group, n = 15), crystalloid (RS group, n =16) and colloid group (HES group, n = 16). An intravenous preload of 8 mL/kg of either lactated Ringer's solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline (P < 0.01). Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respectively (P = 0.362). Intravascular volume preload with colloid is more effective than crystalloid solution in maintaining CO, which may be improved the hemodynamic stability in elderly patients during SA.
本研究的目的是比较胶体和晶体预负荷对老年患者脊髓麻醉（SA）下的心输出量（CO）和低血压发生率的影响。进行了一项随机双盲研究，纳入47例行择期全髋关节置换术（THR）的老年患者，将其随机分为三组：对照组（C组，n = 15）、晶体组（RS组，n = 16）和胶体组（HES组，n = 16）。在SA诱导前20分钟内，RS组静脉输注8 mL/kg乳酸林格液，HES组静脉输注6%羟乙基淀粉，而C组不给予静脉预负荷。C组SA后CO和收缩压随时间有下降趋势。与基线相比，RS组和HES组液体预负荷后CO显著增加（P < 0.01）。此后，HES组CO在SA后30分钟内一直高于基线。收缩压变化与CO相似，但各组与基线相比无显著差异。C组有3例患者发生低血压，RS组和HES组各有1例（P = 0.362）。胶体进行血管内容量预负荷在维持CO方面比晶体溶液更有效，这可能改善老年患者SA期间的血流动力学稳定性。
